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L "0 il N <br /> v � fV W <br /> Cn (D <br /> porn or type Farm Quad. z OMB No.NW-0039 O N ()n <br /> O <br /> JJK N <br /> ID Mumber 0203 .0 911 co v <br /> v 5 CAR00007308 1 �eCrof��+o <br /> - Y TO and M Generators SIfe Address id drfterenl than irr ing address) (Jig <br /> CD <br /> 71 �Oa YUYA RTH MOLES pd <br /> _ Tiver H SEE ROAD m <br /> Q- Zl <br /> (A Greneralli CA 95376 n 2 <br /> ti.T a Company Nine 8b411110 <br /> U.S-EPA lO Number <br /> *01tilLD OIL ENWROOOAEKAL SERVICES CAD 0 2 8 2 7 7 0 3 6 C <br /> y <br /> Tri 2 Company Name U S.EPA IO Number 0 <br /> LID, Rf COVERT SYSTEM Ill l;A R 0 0 01 7 5 4 2 2 <br /> Factkty Name eAd Sxe Addro9s U 5 EPA ID Number <br /> MMIAGEMENT.INC <br /> 8500 US HIGHWAY 85 <br /> YUMA <br /> F -3 p,,, r9� <br /> 'Z 85365 AZR000521146 <br /> 'rJ <br /> ' <br /> 96. 9b U S DOT Desoipi(Including Proper Shipping Name,Hazard Class,V Number. 1 a-Containers ti.Total 12 UnitO <br /> HM and Pack q G cup(ir anY)l 13.Waste Codes <br /> No. Type Quantity Wt I t <br /> O <br /> N <br /> 4 A <br /> K � <br /> LIJ <br /> w O <br /> ZION-RCRA HAZARDOLLS WAS7'i 352 <br /> P � <br /> O <br /> A 0 <br /> 74-Speaat Handling InstruChonS and Additional Information O <br /> EMERGENCY CONTACT:CHEMTREC 1-800.424-93010 WIRES FERMINAL CERES CS NALR"9[31:171.982 171 "PROFILE N v <br /> 981 1626MRSTRAO78 PAPER FILTERS 982'TRA078 162623NRS OILY SOLIDS * *APPPOPli IF Ploi Fli11i iAFN'i �42 <br /> 15 GENERATOR'SICIFFEROR'S CERTIFICATION:I hereby declare[hat the contents of this consignment are fully and accurately described above by the proper shipping name.arra are dasslfred,packaged. <br /> marked and tabeied.'placarded.and are in all respects in proper condition for transport according to applicable international and naFionai governmental regulations If export shipment and I am the Primary <br /> Exporter t cer*that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I ai that the waste mrmmizapon stall identified in 40 CFR 262,27(ai I,f I am a large quantity generator)or(b)(KI am a small quantity generator)is[rue. <br /> YarONerors Pnnted�?yped Name S�lure P,ia�11. r-�.i� fGar <br /> fY_ I <br /> ?8.krlemabo"Shlprnersts <br /> ❑Imporl to US. ❑Expert from U.S. Port of entrylexit: <br /> 7ratelpwlar signature(for exports oni Date leaving U.S.: <br /> 17,11yg1yprterAcknowfedgment of Recoipt of Materials <br /> - �Pr"fted`TypadNar'!el Signature Monih Day Year <br /> PmIO&7yW II r Signature Month Day Year <br /> 6Mraeon Space ❑ o. <br /> ,y ❑Type Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 3 U.S.EPA ID Number <br /> r <br /> O (D <br /> n <br /> hlaAin Day Year v O <br /> Codes{i,e..codes lot hazardous waste treatment.disposal,and recycling systems) 2 <br /> 3, 4 <br /> O <br /> � Un <br /> v 011'receipt of hMirdous materials covered by the manifesl except as ndled in Ilem 19a -t <br /> cD K' Signature Month Day Yaaf 00 <br /> fV W <br /> O <br /> Cn GENERATOR'S INITIAL.COI <br /> i . <br />