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Please print or type. (Form designed for use on elite ( 12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 717468744 st Tracking Number WASTEMANIFEST _ ; ; 1. ,T 1 11 1-800 ) 424 . 9300 JJK 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) US'A, }lt01fJR . ' . Ci ' n '. 1 .. . - :1683 LOUIS 8 [1 AVE U\THRuP t; A ; 5330 Generators Phone: 6. Transporter 1 Company Name ^ U.S. EPA ID Number WORLD OIL ENV! RONiNIE' INTAL SERVICES C AD 0 2 8 2 7 7 0 3 Ei 7. Transporter 2 company Name U.S. EPA ID Number WORLDix11DE RL' CCOVERly ' S'STEIsI INS 8. Designated Facility Name and Site Address C A R O O O 17 5 4 2 U.S. EPA ID Number YUMA YES LLC 2730 E 13TH ST YU1v1A AZ 85365 Facilit (sPhone: g7Q1 ' . et2 aq o A Z R 0 0 0 5 15 9 24 9a• 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers t 1 . Total 12. Unit HM and Packing Group (if any)) 13. Waste Codes No. Type Quantity Wt.IV01, 0 1NOWRCRA HAZARDOUS WASTE , SOLID ( OILY SOLID, PAPER FILTERS) L52 W ZI Z DM 26 C) P W 3. 4 14, Special Handling Instructions and Additional Information EMERGENCY CONTACT : CHEMTREC 1-800424-9300 WOES TERMINAL: * PROFILE # 981 : 162623NRSUSA030 OILY SOLID, -PAPER FILTERS k APPROPRIATE PPE EQUIPMENT ntents of this consignmept are fully and accurately desedbed above by the proper shipping name, and are classified, packaged, 15. GENERATOR'S10FFEROR'S CERTIFICATION: 1hereby declare that the co 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is We. rIntedma Offerors Printed/Typed N me n Month Day Year rial Shipments - - ZImport to U.S. ❑ Export from U.S. Port ofentry/exit: signature (for exports only): Date lea. ' g U.S.: W 17. TransporterAcknowiedgment of Receipt of Materials OTransporter 1 t Woo Name Signature o r Month Day /Year Q Transporter 2 Printed P ypetlName Signature Month Day Year H 18. Discrepancy , 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manliest Reference 186. Alternate Facility (or Generator) Number: U.S. EPA ID Number J U W Facilites Phone: u 18x. Signature ofAltemate Facility (or Generator) Month Day Year Q z w19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) oil C .1 . 2 3 4 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year :PA Form 8700-22 (Rev. 3-05) Previous editions are obsolete.