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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) � Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAD 0 2 8 2 7 7 0 3 6 1 800 424-9300 018 2 3 6 9 31 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> ASBURY ENVIRONMENTAL SERVICES 1300 S.SANTA FE AVENUE <br /> 1300 S.SANTA FE AVENUE COMPTON CA 90221 <br /> GeneratoCfsOPh Phone:ON 310 886-3400 CA 90221 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> .ASBURY ENVIRONMENTAL SERVICES <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEM INC CAR 0 0 01 7 5 4 2 2 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YUMA YES LLC <br /> 2730 E 13TH STREET <br /> yUMA AZ 85365-19 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity WtNol. 13.Waste Codes <br /> L <br /> o NON-RCRA HAZARDOUS WASTE SOLID,(FILTERS CONTAINING_ OIL) ( DM Z10�� P <br /> z 2. <br /> U <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 *PROFILE#9131:081916,9132:081916 *APPROPRIATE PERSONAL <br /> PROTECTIVE EQUIPMENT <�- <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignmentarefully and accurately described above by the proper shipping name,and are classed,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 I am the Primary, <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)yl I am a small quantity generator)is We. <br /> Generatoes/Offer is Pri ted/Typed Na Signature Month Day Year <br /> 16.International Shiplinents <br /> F— ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> T porter 1 P nted yped Name SignatureMonth Day Year <br /> o S C) 03 <br /> a <br /> Z Transporter 2 Print dlTyped Name Signatur Month Day Year <br /> Q <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 181b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q1z <br /> rn <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,8nd recycling systems) <br /> 1. 2. 3. T. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />