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plaaao n't M hm fpnrm eiaeinaam fnr arca nn a1lla 149. lfml twr wrilnr 1 <br />Farm Aonroved. OMB No. 2050.0039 <br />EPA Form 8740-22 (Rev. 345) Previous BOOS are obsolete: DESIGNATED FAiCKITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS W <br />I. Generator ID Number <br />I <br />2. Page 1 of 3. Emergency Response Phone 4, Manifaat Tracking Number <br />016870281 JJ K <br />WASTE MANIFEST <br />CAL 0 0 0 4 15 4 6 0 <br />1 (800) 424.9300 <br />5, Generator's Name and WingAddrsss Generator's Sde Address (B dtHerenl than mating address) <br />TEC OF CALIFORNIA - LOUISE AVE <br />2050 E LOUISE AVE <br />LATHROP CA 95330 <br />Generaloes Phone: 209 859-4110 <br />6, Tmnspater 1 Company Nacos VS. EPA ID Number <br />WORLD OIL ENVIRONMENTAL SERVICES C A 0 0 2 8 2 7 7 0 3 6 <br />7. Transpoft 2 Company Name US. EPA ID Number <br />WORLDWIDE RECOVERY SYSTEM INC, CAR 0 0 0 1 7 5 4 2 2 <br />B. Designated Fedfity Name and SRO Address U.S. EPA It) Number <br />YES MANAGEMENT, INC. <br />6500 US HIGHWAY 95 <br />YUMA AZ 85365 A Z R 0 O 0 5 2 114 6 <br />Facilil es Phone: 92$ 34 SB 8 <br />go. <br />9b. U.S.00T Dasaiplion 0rdudht9Prapar Bhlpping Name, Hazerd Class, ID Number, <br />10. Contalrers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />NO. <br />Type <br />W <br />artPacking Group el anlr)I <br />am* <br />WtNal. <br />IJON-RCRA HAZARDOUS WASTE, SOLID ( OILY SOLID) <br />52 <br />a <br />( <br />DM <br />f <br />/ <br />P <br />a� <br />z <br />2. <br />w <br />C:S <br />3. <br />4. <br />14. Speeial Harding Instruedsms endA40onat Information <br />EMERGENCY CONTACT: CHEMTREC 1-800-424-9300 WOES TERMINAL: CERES CS * PROFILE # 961: 162623NRSTEC606 <br />OILY SOLID * *APPROPRIATE PPE EQUIPMENT ,. O— fD f— }� <br />Zf <br />15, GENERATOR'SIOFFERDR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and at=aWy d scribed above by the proper sh!Nft name, and are dowiffed, packaged, <br />marked and lab61edfplaterded, end sre In all respects In proper mndhlon for transport accordtng to apptlrabp intemaWnal and naBonal govemmenW regulations. If export shipment and 1 am Eha Plilwy <br />Exporter, Ice" That the contents d We conslgnmont conform to the terms of the attached EPAAcknowtedgmernl of Consent. <br />I certify that the waste mirdrrdzation statement IdarORd In 40 CFR 262.27(a) (if I am a large quantity generator] pr (ta if I am a smell quantity gonamor) Is true. <br />Ge ra(gesl0fferor's PhintedlTyped Name 5ignalure Month Day Year <br />tx International S ipmanls ❑ Import to U.S. ❑ Ewort from U.S. Pat of entrwexit: <br />Transportar signature (for exports onlyp: Date leaving U.S.: <br />w <br />17. TransporterAdwMedgrnent of Receipt of Metadais <br />Trarrspoder dnledfTyped Name 11pra M=ffi Day Year <br />.co <br />Trampmer Name S#gnature Mpni)l DayYear� <br />� <br />T � <br />1B. Dlsmpency <br />160. DlsrxOpancy Nolkation Space ouenuly 0 Type ❑ Residue 0 Partal Rojeewn ❑ FW ReJecdlon <br />Manifest Rerrafence Number. <br />14b.Altamate Facility (cr Generator) U.S. t o ID Number <br />v <br />L <br />Fard'rlys Phone: <br />a <br />1 Slgnaturs01mamateFaedlpfa1Ganemlorj <br />Month Day Year <br />z <br />19. Hazardous Waste Report Management Method Codes (i,s., codes for hazardous wash treatment, disposal, and racyding systema) <br />1 <br />1 1 <br />2. <br />3. <br />4. <br />24, Desipmead Faci by owner or operator: Comriicauen of receipt of hazardous matadals covered by the man#fest except as rw En Item tea <br />P ladrrypods _ Signature Month Day Year <br />Via,& 2A 1191 <br />EPA Form 8740-22 (Rev. 345) Previous BOOS are obsolete: DESIGNATED FAiCKITY TO DESTINATION STATE (IF REQUIRED) <br />