Laserfiche WebLink
' P"(ea epri i ortype.(Forth designed for use on elite(124dch)typevAter.) r 1 •Form Approved.OMB No.205HO39 <br /> ' UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest king Number ® <br /> WASTE MANIFEST ®F <br /> 5_Generator's Name and f++4arTng Address s da dress(d different than mairog address) <br /> JKC TRUCKING <br /> 3400 NEWTON RD <br /> Gencrat�s �1 EDt:fl I VIV,� l�11T5 ` <br /> 6.Transporter 1 Company amF U.S.EPA ID Number a <br /> AMERICAN VALLEY WASTE OIL,INC.. CAROW2 <br /> 7.Transporter 2 Company Name U-S.IPA ID Number <br /> ASBURY ENVIROMENT'AL SERVICES CA002277 <br /> S.Designated Facx'Gty Name and Vile Address U.S.EPAID Number <br /> YU1M YES LLC <br /> 2730 E.13TH ST AZR 1 4 <br /> YUM&AZ a53S;'i *� <br /> Faa'lil7rs <br /> Ba. 9b.U,S,DOT Dei ipfvn(including Proper Shipping Name.Hazaid CEa'ss,ID Number 1©.Cantalrers' 11_Tata! 12.Unit <br /> HM and Paddng Grwp(f any)) No. Tye Quantity WtNaI. 1�-Wpste Codes <br /> 1 NON-RCRA KhZZARDOW WASTE SOLID,ASWRBENTS OIL,.,, 1 DM 165 P 352 <br /> PAPER OIL FILTERS <br /> Fr.r a'r r <br /> 3. <br /> 4 <br /> .4 <br /> 14_Special Handling Instructions and Additional Information <br /> PROFILEN 181 WN90 P-S PAPER FILTERS ERC 179 <br /> EMERGENCY CONTACT'EFRIN 6 r� <br /> 15. GENERATOR'SIOPFEROR'S CERTIFICATION:I hereby declare that the contents of This consignment are rutty and acc uatety desodbed above by the proper shipping name,and are dassilied,packaged, <br /> madred and tabeledlplacaided,and are in all respects it proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Fxpfr,I certify that the contents of this consignment conform to the terms of the attached EPAAdwcvA*rnent of Consent a <br /> I ce")hat the waste minini¢ation statement idenLlied in 40 CFR 262.27(a)(if I am a large quantify generator)or(b)(if I am a small qumntity generator)is true. <br /> Genera6nts10tferorsPrimedlTypedName 7Signature Month. Day Year <br /> ®P �� <br /> 1 16.International Sh-Tm % <br /> e— ❑Import to U.S. ❑Expout from U.S. Pon of entrylexit: <br /> ? Transparfer signature(far exports only): Date leaving U.S.: <br /> LLI '17.TransporterAdoDwledgrmntdRewptofmaLlfbis <br /> Trams yped a Sig Month. Day Y <br /> O <br /> u7 <br /> Q T r I nature "' orth Y <br /> �..� d� Z. f <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Aartiol Reyedon ®Ftr1l Re)ectiorn <br /> Mantk:st Reference Number: <br /> 1 tab.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Facbtty's Phone: <br /> W 18e.Signature of Alternate Facility(or Generator) Monlh Day Year <br /> Q <br /> a <br /> 19.Hazardous Msq Report Management Method Codes(ie..codes for hazardous waste Treatment,disposal,and recyding systems) <br /> ® 1. 2. 3. 4. <br /> 2E}.DPsignaled F i Onmer or Operator.Certiff anon of receipt of hazardous materials covered by the manifest except as acted in item 18a <br /> Printedflyped Name Signature Month Day Y r <br /> EPA Form 8700-22{Rev.3.0 i taus ed's6ons are obsolete. <br />