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_ 1 <br /> Please print or type.(Foro1 designed for use on elite(12-p,tch)typewriter.) Form Approved ONIB No,2050.0039 <br /> UNIFOR HAZARDOUS I 1,Generator ID Number 2.Page 1 of 3 cme'gsrcy R=sperse Phare 4.Manifest Tracking Number <br /> .ofEMANIFEST 011094425 FLE <br /> 5.Genes ators Name aid t.lallirg Address veratars 5 e Addie�s is ditte�anl!",+n, ;h.,,.g aCJrt•;;) <br /> Ampco Pumps Company <br /> 1018 Shaw Rd <br /> Stockton, CA 95215 <br /> Gerw_ralor s Ph-0 <br /> G.lrarSporlerIompany arre J.S EP?,iD r;um er <br /> A hmced Chemical Transport Inc. (SV) CAR000070540 <br /> 7 Transporter 2 Company Narre U S.EPA 10 N;mfr <br /> Worldwide Recovary System, Inc CAR000176422 <br /> 8 Des,grated Facility Naas aid Site Address J S EPA ID Number <br /> Yuma YES, LLC <br /> 2730 E. 13th St AZR000515924 <br /> Yuma, A2 85365 <br /> Fa pity s Phone: <br /> ga 9b.U.S DOT Descdplon(including Proper ShiwrV Name,Hazard Class,ID Number, 10 Co!' Hers 'i Tofal 12 Um' 13 ,Y'as:e C_1es <br /> HM and Packing Group(if any)) No iyps Quar+fily Q°do; <br /> Non-RCRA Hazardous Waste,Solid,(Oily soUds) P 352 <br /> z 2 <br /> DIM z5 S <br /> W <br /> 3 <br /> 14 Special Hand ig lnstr-tions and Adu t,ora ln'^rmatron F'"ac:t Nt.M bw 140496 Downant#:0168600 <br /> 1) 176557 AMY--0.,j 7_00 Z ZX 5 S O T <br /> 15 GENERATOR'S10FFEROR'S CERTIFICATION: I hereby de;lare;h ;!ne contents of this oorsignmert are fury and accurately descrbed abo'.-e by t:^.e p ropar sh:ppmg Haute,and are classified.packaged, <br /> marked and Iabeledlpacaidert.and are in all respects r,proper m.^:d tan for Uansport aocordiq to app;icatke+nternahonat and rational goierr^renlal regulaiVis.If export shipment and I am v s Primary <br /> Exporter,I certify that the contents of this coni gnment conform to the terms of re attached EPAAujiowcdgmert of Consent. <br /> I certify that the waste minimization statement:dent+fled in 4P CFR 262 27(a)(if I im a large geantrty gersrafar)m!.h)(i l am a small quanfity generatori is tri., <br /> verators,' :.er rs ntad yped Name r a pre c-. ,ay ear <br /> /o z <br /> 16 lntemational Shipments <br /> I- ❑Ptpon to U S Export from U S Po'?of e ry'ent <br /> Transporter Signature(for el(pr,15 rr Dare lea 71x0 U S <br /> w 17 Transporter Acknowledgment of Receio of Mateaals <br /> Ttansporter 1 Peh!ed,'Typed Na _9'atve Me. ., D ay Year <br /> IxN <br /> Z Trarspc r 2 n7tet4'fyped Narne // ature cr/h� ay zar <br /> 41 - <br /> t V <br /> 18.Di <br /> sue <br /> t8a -repanc I! ration Spa.•e D wa'bly Ll e ElResrdw L__)ParBa;Re e.lion ❑F,;l Reject an <br /> E <br /> Manifest Reference N,Mbrf <br /> 1e5.41erna,eFaclRy(or Citfwatot) US EPA 10Namt>pr <br /> J <br /> U <br /> Q <br /> LL Faaiih's Phone: <br /> W IE,SgralueofAlieRaleFau:ly(orGenerator} N!Qnth Day Year <br /> Q <br /> Z <br /> mN'19 �iaza�d"s -te Report Management Method Codes(i.e.,codes for hazardous waste treatmert,disposal.and recychng syatems? <br /> 0 1 2. 3. a <br /> 26.Des 1n�d Faahly Oa r cr 0; r ter CeKifica'or.of cd hazardous r zti .I ._.er "the rear fest exce t as roles in item i8a <br /> Prnlyd-Tyficd Nr'rq S."nitura Month Day Year <br /> o <br /> EFA Form 8760-22 tRev.3 45} Previous ons are obs,lete. DESIGNATED FACILITY TO DESTINATION STATE"l REQt11R D� <br />