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• V <br /> Please print or type (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2 Page 1 of 3 Emergency Response Phone 4.Manifest lrac Number <br /> WASTE MANIFEST CAL00026642111 � <br /> _; 7,2 0112 9597 FLE <br /> 5 Generator's Name and Ma±linq Address Generators Site Address fit different than mailing address <br /> Simpson Strong Te Inc. <br /> 5151 S AIRPORT WAY <br /> Stockton, CA 95206 <br /> Generator's Phone q ? <br /> 6 ransportert cmpany ame U.S EPA ID Number <br /> Adiianced Chemical Transport Inc. (SV) C.AR000070540 <br /> 7 Transporter 2 Company Name U.S EPA ID Number <br /> Worldwide Reca'•Jery System, Inc CAR00017542 <br /> 8,Designated Facility Name and Site Address US EPA ID Number <br /> Yuma YES, LLC AZR000.515CJ2.4 <br /> 2730 E. 13th St <br /> Yuma, AZ 85365 <br /> Faai t's Phone: 928-34A-9828 <br /> 9a 9b.U.S.DOT Descriptor 4ncluding Proper Shipping Name,Hazard Class.ID Number 10 Containers 11 Total 12 Unit 13 Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt ftl. <br /> 'Toil-RCRk I lazardous Waste Solid(Oih,Solids) C7M ii X52 <br /> 1 C)Z <br /> LU �cxi-RCRA HaLardouz,Waste,Liquid, (;lftltlr(-eze and Water) 35 <br /> �A �/ � � <br /> 3, <br /> I <br /> 4 <br /> 14 SpecW Handling Instructors and Additional Information R 'Cct Number 159566 Document# n191302 <br /> 1) 174810 SIY- =Q 'Q0 �,5xn OTM) -14r1 <br /> 1,76633 SIY-00(9 01Z)"S C 4 (1 <br /> 15 GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents cmis consignment are full above by the proper shipping name,and are classified,packaged. <br /> marked and labeled placarded,and are in all respects in proper condition for transport according to appGcab ntema5onal and n tionalvemmental regulations.H export shipment and am the Primary <br /> E ify that the contents of this consignment conform to the terms of the attached EPA ACknowl gment of Cance <br /> certify that waste minimization st ent tified in 40 CFR 26227(al(if I am a large quantity ge rator)or(b)(if I am a all amity nen is true. <br /> enAsiCifferonted Name u on a ear <br /> rU(m� t8 <br /> � 18.Int nal Shipments f(���'II <br /> F t�t import to U S ❑Expor,from U. Port of exit <br /> Z Trans iter sa nature fore Date leaving U.S <br /> X 17 Transporter Acknowledgmen f Receipt of Materials <br /> Tratert PnntedtTyped ignatureMonthay ear <br /> O ` <br /> a <br /> 111 191 <br /> Z Trans Name ignatu Month Day qK <br /> 6 LY <br /> 18a Discrepancy Indication Space E] Quantityyp 1 1 <br /> ElT e El ❑Partial Rejection ❑full Reaction <br /> Manifest Reference Number: <br /> 18b Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> v <br /> a <br /> t1 <br /> Facility's Phone; <br /> 18c Signature of Aftemate Facility(or Generator) Month Day Year <br /> W <br /> Q <br /> Z <br /> rn <br /> 19 Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal.and recycling systems) <br /> C3 1 2 3. 4. <br /> � <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 as <br /> Pdnted,Typed Name Signature Month Day Yea, <br /> Lt <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TG DESTINATION STATE)IF REQUIRED) <br />