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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Geu <br /> r t r 2 Pa e 1 of 3. a Phone 4.Manifes�t Trackin Nube�rry <br /> WASTE MANIFEST r �� �'f' o20 1 0 ;,� 6 4 ass: l D 3 G B F <br /> 5.Generator's Name and Mailing AddreNORC,AL MASTERCRAFT Generator's Site Address(if different than mailing address) <br /> 3401 S.WHISKEY SLOUGH RD <br /> STOCKTON,CA 95206 <br /> 925-460-9216 <br /> Generator's Phone: <br /> 6.Transporter 1 Company NameAMERICAN VALLEY WASTE OIL, INC. U.S.EPA ID NumberCAR000272302 <br /> 7.Transporter 2 Company NameWORLDWIDE RECOVERY SYSTEMS INC U.S.EPA ID Number i;ARUOO t t'i,122 <br /> 8.Designated Facility Name and Site AddressYUM A YES 2 WAS 1 E'1"°RANSFER FAGi LITY U.S.EPA ID Number AZR000521146 <br /> 8500 US HIGHWAY 95 <br /> YUMA,AZ 86365 <br /> 928-344-9828 <br /> Facility's Phone: <br /> 9a 91b.U.S.DOT Description(including 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.Nol. <br /> 1. CRA HA ARDOUS WASTE SOLID,ABSORBENTS,OIL& 1 DNI ?15 1 <br /> O <br /> 0 DIESEL I <br /> a _ <br /> i <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> i <br /> 14.Sp�r,'tal'andljgg Instructions and Additional Information BSORBENT,OIL ERCP#171 <br /> hEMERGENCY CONTACT.VIVA A <br /> Yl 963 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described 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 applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the was inimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> G nerat / ro s P' d ped N " Signa re Month Day Year <br /> 2. 1ZLE6 <br /> 16.Interional S pm nts <br /> F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> OTransporter P'nted/T ped Name Signature '� ,._-Ahor tfi Day Year <br /> CL �,o,-Ig; X r <br /> C0 Tr sporter ed/Typed Name , / Sign re Month 'DAY- <br /> S <br /> ay Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Res(u) Partial Rejection j <br /> ❑ El Full Rejection <br /> Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1, 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. I),Cl'(t;R.O,',°, I"."' <br />