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Please print or type.(Form destined for use on elite(12-pitch)typewriter.) Form Approved.OMB No:2050.0039 <br /> UNIFORM HAZARDOUS , �nID Number 2.Pte, 3.E Phone 4.®5Tracking <br /> r 2 Number <br /> 6 9 6 3 JJ K <br /> WASTE MANIFEST CAL 0 0 0 3 6 6 21 1 1 (800}424 9300 <br /> 5.Gener%Ng and <br /> #I.Addi s etas Site Address(�f different than mailing address) <br /> 720 E,HAMMER LANE <br /> STOCKTON CA 96210 <br /> Generators Phone: 209 951-2403 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transputer 2 Company Name U.S.EPA 11)Number <br /> 8.Designated Facility Name and Site gess U.S.EPA ID Number <br /> YUMA YES LLC <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 AZR000515924 <br /> Facilitys Phone: (928)344-9828 <br /> 9a. •9b.U.S.DOT Description(including Proper Shipping Name,hazard Class,ID Number, 10.Containers 11.Total 12.Unit i 13.Waste.Codes <br /> HRA and Padorg Group(if arty)) No. Type Quantity WL/Vol. <br /> NON-RCRA HAZADOUS WASTE,SOLID(NON-CONFORMING FILTERS) �3 I <br /> DM P ' <br /> 2. <br /> C9 . <br /> { <br /> 3. I <br /> 4. <br /> 14.Spedal Handling instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800.4249300*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT *EMERGENCY <br /> CONTACT CHEMTREC 800 424 9300 * TRUCK# PROFILE#1616231NRSFIR62 �^ <br /> 15. GENERATOR'.S/OFFEROWS CERTIFICATION: 1 hereby dedere that the contents ofthis consignment are fully and accurately described above by the proper shipping nom,and are classified.pad urged, <br /> marked and labeled/placarded,and are in all respects In proper caiditiar for transport ac=ting to applicable international and national governmental regulations.If e)W shipment and t am the Primary . <br /> Exporter,I oertify that the contents of this t con td the terms of the attached EPAAdt Wedgment of Consent. <br /> I certiry that the wash ng statement 40 R 262.27(a)(8I am a large quentity generator)or(b)(Ki am a ter)Is tau®• <br /> stOlfemrs Pmt natrure Month Day Year. <br /> J 16.International Shipments import to U.S. ❑Export from U.S. Poll of antrywlt <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TranspotterAdorovAedgmerd of Reoeipt of Materials Month Day Year <br /> ET rter i Prl y arae Signature <br /> 0 ! /! <br /> ZTransporter 2 PrintedVIrel Name Signature Month Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space. .Quantity ❑Type [71 Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 'Ift Alternate Fadlity(or Generator) U.S.EPA ID Number <br /> J - <br /> V <br /> GFa�it/s kone:Alternate Facility Day Year <br /> w 18c.SgnatrMe ofAlternateFacility(or.Genaa <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W2 3, 4. <br /> 20.Designated Facility Owner or Operator.Certification of of hazardous materials covered by the manifest except as rimed in lterh 1 Ba <br /> Printedll'yped Name Signature month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DEEIONATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />