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netl'se print ot'type. Forrn Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number " 2.Page 1 of 3.Emergency Response Phone 4.Mani/est Tracking Number <br /> WASTE MANIFEST CALOW440054 1 209.2754DOWGBF <br /> 5.GeneretMs Name and Mailing Address Generators Site Address(if different than mailing a. re <br /> DHALDNAL BROTHER TRUCKING <br /> 15W MCIONLEY AVE <br /> Ganemmrs Phc LATHROP,CA 95339 <br /> fi.Trensporter 1 ompany arae U.S.EPA ID Number <br /> AMERICAN WALLEY WASTE OIL,INC:. CARD002723M <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEMS INC CARO(Xg17S422 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YUVA YES 2 WASTE TRANSFER FACILITY AZRODO521148 <br /> 65M US HIGHWAY 95 <br /> YUMA,AZ 85385 <br /> ±!2,'s Phon <br /> ge. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, Typo <br /> 10.Containers 11.Total 12.Unit <br /> HM and No.Packing Group(if any)) Quantity Wt.Nul. 13.Waste Codes <br /> 1. <br /> o NON-RCRA HAZARDOUS WASTE SOLID,ABSORBENTS, PAPER OIL OM t r p 2 <br /> fiLTERS6DEBRIS _ <br /> w J <br /> z 2. - <br /> w <br /> c� <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional information <br /> PROFILE*191321INRS PAPER FILTERS ERG1111 171 <br /> EMERGENCY CONTACT:JASPRIT <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplap7ded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cortity,that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I cer5fy that the waste minimization statement identified in 40 CFR 262.27(a)(d 1 am a large quantity generator)or(b)(NI am a small quantity generator)is We. <br /> GeneretoYs/Offerm's Printed[Typed Name SignatureMonth Day Year <br /> 7 �— 4 } <br /> J 16.International Shipmen -. <br /> 1— ❑Import to U.S. ❑Export from U.S. Porlof entry/exit <br /> 3 Transporter sgnature(for exports only): <br /> Data leaving U.S.: <br /> W 17.TransporterAdmavledgreanl of Receipt of Materials <br /> oc Transports 'n yped Name Si M Day Year <br /> CL <br /> W Tra orleF7FWe-cQlyPe0Na1ha Signature l� Month DSy' Y r <br /> Air <br /> }. 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Ouanlity Type ❑Reidue Partial Rejection 1s ❑ <br /> Y• El Full Rejection <br /> Manifest Reference Number: <br /> 186.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> ' Maj 1So.Signature ofABerrate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> ca I <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in fee <br /> PnntedrryW Name SignaNre Month Day Year <br /> EPA Fom 8700-22(Rev.12-17) Previous editions are obsolete. SIGNATED FACILITY TO GENERATOR <br />