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PlaasQ nrint nr tdne. (Form designed for use on elite (12=oitchl tvoewnteri!' . - Form Aboroved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3.05)'Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) '. . , , • . � ', . ; . .'.1'2985;1609' : , •, . � ' , _ ._ ; . . UNIFORM HAZARDOUS 1. Generator ID Number CAL 0 0 0 4 '15 4 6 0 2. Page 1 of 1: 3. Emergency Response Phone 4. Manifest Track] Number 4249300 p 17 7.912 5 5. p... J J K WASTE MANIFEST - - 5. Genet�s�N�rrr�c��MR4Adress Generators Site Address (If different than mailing address) 2U50 E LOtiISE AYE. LATHROP CA 953.30 Generator's Phone: 2698.%4110 6. Transporter 1 Company Name U.S. EPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7. Transporter 2 Company Name U.S. EPA ID Number WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 017 5 A 2 2 Ae- . 8. Designated Facility Namaland Site Address U.S. EPA ID Number YUMA YES LLC 2730 E 13TH ST' .` YUMA AZ 853&5 AZR000815924 Facility's Phone: '(928)344-9828 ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Gass, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM ':and Packing Group (If any)) Quantity Wt-Noh '-NON-RCRA HAZARDOUS WASTE, SOLID ( OILY SOLID. PAPER FILTERS) '-} 362 DM e� W ' L7 ' A-' 90,P-Zi7 7 017"(9>2 5,,1•) 4 - `V `f 5kl�C r. 14. Special Handling Instructions and Additional Information D 6W EMERGENCY CONTACT: CHEMTREC 1-800.424-9300 WOES TERMINAL: CERES CS * PROFILE N 981: 162623NRSTEC606 OILY SOLID, PAPER FILTERS'" *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 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 classed, packaged,' marked and labeleWplacarded, and are in ail respects in proper condition for transport according to applicable international and national governmental regulations. If exportshipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAeknowledgment of Consent. , I certify that the waste minimization statement identified in 40 CFR 162.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Ge erator'slOfierors Printe yped Name SignatMonth Day Year .� � 16. International Shipments ❑ Import to U.S. ❑ Expori from U.S. Part of entry/exit: Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Transp-qrt II Printte , yped Name Signature ^ Month _ Day 'Year .X ;Trjp;t`j to yied' Name, : , ►? ign • , Da Y ar 18. Discrepancy " 1Be. Discrepancy Indication Space ❑ r ,, _ Quantity ❑Type ❑Residue _ ❑Partial Rejection ❑Full Rejection ' Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number J W Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day" Year' H19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) C 1. 2. 3. t 4 _- 1 "i i 20. Designated Facility Owner 6i Operator: Certification of receipt of hazardous materials covered by the manifest except as in Item 18a ai Signature Month Day,;,: Year d/�Typed Name fi �( EPA Form 8700-22 (Rev. 3.05)'Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) '. . , , • . � ', . ; . .'.1'2985;1609' : , •, . � ' , _ ._ ; . .