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Please pr nt or type <br />A <br />cc o _,....- <br />UNIFORM HAZARDOUS <br />INASTE MANIFEST <br />1 Generator ID Number t b <br />CAL 000194471 <br />2. Page 1 of 3. Emergency Response Phone <br />(80O424-9300 _ <br />4. Manifest Tracking Number <br />023183492 JJK <br />5 Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) - <br />- fs,,TRAL VALLEY WASTE SERVICES INC CEN644 <br />P 0. BOX 241001 **SEE NOTES FOR \, <br />LODI CA 95241 1333 E TURNER Rr , A '..L.:E NC:1-E.':'... c'.. <br />Generators Phone: 239 333-5655 I LODI CA 95240 <br />Transporter 1 Company Name U.S. EPA ID Number <br />WORLD OIL ENVIRONMENTAL SERVICES I C A D 3 2 8 2'? 7 0 3 6 <br />Transporter 2 Company Name U.S. EPA ID Number - <br />WORLDWIDE RECOVERY SYSTEM INC. I CAR 0001754 2 -2 <br />Designated Facility Name and Site Address U.S. EPA ID Number — <br />'YES MANAGEMENT. INC <br />6500 US HIGHWAY 95 <br /> <br />YUN1A AZ 8536F- L A Z R () 0 0 -5 2 11.1 4 6 <br /> <br />Facility's Phone: (928)344-9828 <br />ga. 96. V S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br />NM and Packing Group (if any))13. tio Type Quantity Wt_Nol Waste Codes <br />1, N ?N-RCRA HAZARDOUS WASTE. SOLID (OILY SOLIDS) <br />( <br />_ <br />/06 4 GENE ., <br />14. Special Handling Instructions and Additional Information <br />ErvlEF.GENCY CONTACT CHEMTREC 1-800-424-9300 WOES TERMINAL: CERES CS NAERG# 9E1 - - ' ° OFIL ;E .1 <br />CENE44-2092901NP3 OILY SOLIDS/ABSORBENTS " :'" APPROPRIATE PPE EQUIPMENT c_ /6.---S------- <br />16. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the per s ipping name, ard are classtfied, packaged. <br />marked and labeled/placarded. and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and lam the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) • I am a smal ntity genera ) ' true <br />• <br />GeneratorA'OVeror s Printepitypeo Name / Signaler <br />lc puets , 1 l' <br /> <br />Day Year <br /> <br />EZ in 17L <br />..- <br />K <br />International Shipments Li from Port Import to U.S Export U S. of entryiexit <br />Transporter signature (for exports only): Date leaving U.S.: <br />F5 Transporter Acknowledgment of Receipt of M enals -I TRANS PORTE Transp 1 Pi tediTyped N Signature Month Day Year <br />10111.- # 1 II -c7--k I7e- 1 Z I <br />Tr i. xorter 2 Print-. .e •m Sign. . - <br />I I- <br />t lonth a Year <br /> i I V-2- 4-- DESIGNATED FACILITY 8 Discre.an <br />Discrep dication Space Quantity Type L Residue L Partial Rejection <br />Manifest Reference Number <br />r --- Li Full Rejection <br />Alternate Facility (or Generator) U S EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility Or Generator) Month Day Year <br />i I <br />19 Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />20. Designated Fax i Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as icted in Item lea <br />Printedayped Name ,n RIO ....., <br />-Au* Signature 1 __ __ .. <br />Month Day Year <br />01 lUip12- - <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are o lete. S e-