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Farm Approved.OMS No,2050-4039 <br /> Please print or Ill 2.Page t of 3,Emergency Response Phone 4.IAanlfest Tr"l lag NUMb" ( <br /> 1lNIFOR1 HAZARCol15 <br /> 1.Gesteralor 14 Number � 4$�t,7��Z�-���� 020380 <br /> 673 J J 1\ <br /> NIASTE ylAt�)FEST CAL 0 0 Q 3 6 6'7 Generator's St1s Address(d d'd€errrnk than mailing address) <br /> 5.Ganeralof&Name and Mailing Address <br /> IMPERIA€ TRUCK WASH AND REPAIR JAll ZR UP 4 IC <br /> 2142 W. OM <br /> AVE CA 95337 <br /> M, ANTECA <br /> Generekor s Phane'. 20 239$111 U,S.EPA1DNumbsr <br /> &.Transporter 1 Cornpeny Name C A❑() $2 l i 0 3 G <br /> 11ORLn OIL EN+13H0NM LNTAL SERVICES U,3.EPA lD NumDer <br /> 7.Transporter 2 company Name CRR 0 0 0 17 5�1 F 2 I <br /> WORLDWIDE RECOVERY SYSTEM INC. U.S EPA IDNumbef <br /> B.Designated Facility Name and Sile Addre54 <br /> YES MANAGEMENT, INC. <br /> 6500 lis H;GHWAY 95 A' 35 15 AZ R 0 0 l� 5 2 114 b <br /> YUMA <br /> Faciii s Phone: y 10.Containers 11.Toles 12.UnK 13-Waste Codes <br /> 4b.U.B.DOT Desaiptbn(invading tamper ShWN Name,Haterd Cil ID Nurrbm, No. T'po ouantitty WLNd- <br /> ill and pxScbng Group(d any)) <br /> HM :SJ2 <br /> I-wN•RCRA HAZARDOUS`BASTE,SOLID(PAPER FILTERS) � D M <br /> z 2. <br /> w <br /> cry <br /> 3. <br /> 4. <br /> 14.Spell k3andling[nsWch'ans and Addiliona!tnformatlon <br /> EMERGENCY CONTACT :CfJEMTREC 1.804424-9300 WOES TERM <br /> ItEAL: CEr�E5 CS PIACFtG#J6 r 1 `PROFILE 951 <br /> # <br /> 1.5262W,iq.'31MP072 PAPER FILTERS K *APPROPRIATE PPF-I QUIPFAE�iT , <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I harablr declare that the Contents vt INs cons}gnmanl are <br /> fully atcUrateiy described eb niby the l shipping W name,art!am d sited,package 3, <br /> marked and tabelediptaeardsd, <br /> and era In AN respacls k,proper cordiklen ref tmmporl scmrMm9 to appilcsbie Inlematianal rad nalianal govammental("llH export stupmenf and I am tits P rnary <br /> Exporter,I cerihy that eco cWti as of this conmignmenl a>nromt to the ler+ns of the rn ac3ted qubAEPAt,ty gorkdgmenl of OmsanL <br /> tllama usnttygenarstnr)dr(b)silkam srnallquanttygenerdlor)istrve. Mond Day 1(ear <br /> I rx�ty that the waste minlmixatlon statement Identlfted m 40 GFf�262.27(a)( �+4 Slgna�sre <br /> Geysratoesloffietoe3 ypad Nems Q <br /> 1� .l <br /> 16.intetnallonal SH nts ❑Exppli U.S. 1 o4 anlryj*At., <br /> ❑trill to U.S. ala kvaying U.S.;. <br /> M Transporter signature(for oxports only): <br /> a!� 17.TransparlerA6wxm4edyraent ofRecelptofMal Will?)) Day /Year <br /> Transl>d PrintadlTyped Name� <br /> Month Day ear <br /> N Transporter I Name <br /> S tare <br /> s <br /> 1— <br /> 18.DlsCrepancy r� <br /> LJ <br /> 1 Be.Dlscte , indication Space ❑ Ouanfity Type Res ue ❑ Rel,& ❑Full Re)ecdon <br /> Manifest Refefence Number; <br /> U.S.EPA IR Number <br /> 18b.Alemate f864(Of Generate) <br /> Facility3 Phone: MWIh pay Year <br /> i ft.Signature of Alternate Facility(or Generator) <br /> MH Moos Wade Report MangM`at d Ua3(i.e.,oadaa for h@a�rdova waste treatititent,d�posai,sad recydlrtg systems) <br /> o i gement 2 3 4, <br /> 20.De slgnatad Faclllty Umar or Operator.Cerlifteation of receipt of hazardous malerlals covered byte manifest except as ncfed to Item 18a Mond Day Year <br /> Pdntedffyped Na Signature <br /> LSE G <br /> EPA Form 8700-22{Rev.12-17} Precious editions are obSo9e TED FACILITY TO EPA',D-MANIFEST SY5T'E11 <br />