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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 I.Gerterowr ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 415 4 6 0 1 (800)424.9300 ®1 1 J J K <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> t",ALIFORN1A-LOUISE AVE <br /> ' <br /> Ll <br /> SE AVE <br /> _ iHROP CA 95330 <br /> Generators Phone: 209 658-0110 <br /> 6.Transposer i Company Name U.S.EPA ID Number <br /> i., .'_NMENTAL SERVICES CAD028277036 <br /> 7.Transporter 2 Company Name U.S.EPA ID um <br /> Nber <br /> WORLDWIDE RECOVERY SYSTEM INC. <br /> 8.Designated Facility Name and Address U.S.EPA ID Number <br /> CAR00017 ! - <br /> YES MANAGEMENT.T,INC. <br /> -::1:? !!S HIGHWAY 95 <br /> AZ 85365 <br /> Facility's Phone: A Z R 0 0 0$2 114 6 <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 Wt.NoL 13.Waste Codes <br /> 0 1.NON-RCRA HAZARDOUS WASTE,SOLID(PAPER FILTERS) 352 <br /> a <br /> DM f-7S P <br /> Z 2 <br /> w <br /> (0 <br /> 3. <br /> Tom_ <br /> 4, <br /> 14.Special Handling Instructions and Additional mformation _ —IS <br /> EMERGENCY CONTACT :CHEMTREC 1.800.424-9300 WOES TERMINAL CERES CS NAERG#961:171 *PROFILE#9B1 <br /> 162623TEC605 PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT # �} a '� a x 5,-S, <br /> r Tr rh <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: ereby all the contents ofthis consignmentam fullyand accurately described above bythe propershlpping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper co editiooiartransport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cemly that the contents of this consignment conform to the terms of line attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(H I am a large quantity generator)or(b)(if I am a small quantity generator)is has, <br /> Generators/Offerors Printedr-yped Nam. Signature Month Day jYear <br /> y 1 <br /> � i6.International Shipments ! U <br /> i ❑Import to U.S. EJ Export from U.S. Part of entry/exit: <br /> Transporter signature(fa exports only): Date leaving U.S.: <br /> W 17.TransporterAcknowledgment of Receipt of Materials <br /> Transporter i Psntec/Typed Nis ff . Signature _ �' Month Day Year <br /> ^; rI <br /> Trans iter 2 Prin yped Na Signature Month Day Year <br /> r <br /> r18.Discrepancy / <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejecbon <br /> Manifest Reference Number: <br /> iBb.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facilitys Phone: <br /> W 18c.Signature of Ahemate Facility(or Generator) Month Day Year <br /> ZZ <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1 2. 3. <br /> l/ I 11 4. <br /> 1 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item f8a <br /> Printed/Typed Name SignatureMonth Day Year <br /> l <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. \DESIGNATED FACILITY TO GENERATOR <br />