COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Please prini 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 4.Manifest TraQekiiog 1Jum23 `b�er�} Q WASTE MANIFEST (:r'",!.0 0 0 2 7 6 G G J 1 (.801?) 424-9300 0tJ I l� L✓ S.Generator's Name and Mailing Address Generators Site Address(if different ihan mailing address) PROFLEET INC- PP,0 r(M 15453 t°I.Tiir)PN T t=N RD. LOCI CA 95242 15453 N.THORN"1ON PD. Generators Phone: -909333-8383 l_OIDI 0A 952 42 6.Transporter 1 Company Name U.S.EPA ID Number WORLD OIL f=NVJRO3,I NIENTAL SERVICES CAD 0 2 8 2 7 7 036 7.Transporter 2 Company Name U.S.EPA ID Numbar WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2'2 8.Designated Facility Name and Site Address U.S.EPA ID Number YES MANAGEMENT, fNC. 6500 US HIGIA ldAY 95 YUMA A7 8536= AZR000521. 146 FacilitysPhone: (298)340-9898 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11,Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WLlUOI. t.NON-RCRA NAZARDOUS WASTE,SOLID PAPER FILTERS + ! :362_. m DM ? P 2.UA r I ( 3. 4. 14.Special Handling instructions and Additionm Informations EMERGENCY CONTACT.,CHEMTREC I-800-424-9300 WOES TERMINAL.,CERES CS PROFILE it 9f3I.:162623NRSPROIOB PAPER FILTERS *'APPROPRIATE PPE EQUIPMENT 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged, marked and labeledlplaorded,and are In all respects in proper condition for transport according to applicable Womagonaland national governmental regulations.If export shipment and I am rho Primary Exporter,f certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if f am a large quantity generator)or(b)(if I am a small quantity generator)is true. Genoatoesltj erors Prinlef peri Name Signature 01 Month Day Year Q� �3 F-11 16.International Shipments ❑Import to U.S. ❑Export from U.S. orl of entrylexit: Transporter signature(far exports only): date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials LLJTrans er t Pdntedlfyped blame Si ore .._Month Day Year l.� Month Day Year P Z Transporter 2 Pdnted[Typed Name Signator! Q 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection i; Manifest Reference Number: U.S.EPAiD Number 18b.Attemale Facility(or Generator) la Facility's Phone: .. w 18c.Signature of Alternate Facility(or Generator) Month Day Year a - 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 2. 3. 4. r li 20.Designated Facility Owner or Opemtoc Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a Printedffyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. f3ESIGh1ATEp FACIL tT1'TQ ❑)~STINATtON STATE(1F REQUIRED)