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Please print or type. Form Approved , OMB No. 2050.0039 <br /> UNIFORM HAZARDOUS i . Geoaralor ID Number 2 . Page i of 3 . E3nentency Rcsrronsa Phone. 4. Manifest Tracking Number <br /> WASTE MANIFEST CAL0000181286 1 1 1388 7$ 5 7225 012 2 8 1.0 8 0 F L E <br /> 5. Generator's Name and 1.1ailing Address Gnr1erotor's Sile Addfass (if different than mailing address) <br /> Advanced Industrial Coatings <br /> 950 Industrial Dr rA <br /> Stockton , CA 95206 ECEIVED <br /> Generators Phone: 209- 234 - 2700 <br /> G. Transporter 1 Company Name U.S. EPA ID Number <br /> Advanced Chemical Transport Inc . / DBA ACT FNVIRO � k CAR000070540 <br /> 7 Transporter 2 Company Name U. S. EPA ID Number <br /> Worldvvide Recovery System, Inc CAR000017542. 2 <br /> 6, Designated Faci=ity Name and, Sile Address DEPARTMENT <br /> �27� �'� �� � � U .S EPA ID Humber <br /> Yuma YES , LLC AZR000515924 <br /> 2130 E . 13th St <br /> Yuma , AZ 85365 <br /> Facility's Phone: 928-344-9828 <br /> 9a , 9b U. S . DOT Descnpt;oo (including Proper Shipping Name, Hazard Class, iD Number 10, Containers 11 , Total 12. Un;t <br /> HM1 and Pac^ndg Gruup (n any)) hto, Type Quantity ;"R .Aroi. 13. Waste Cods <br /> i .Non . . (AZA Hazardous Waste Solid ( Dried Pail] () CF P 7941 <br /> 0 2iLj <br /> z2 <br /> W <br /> 3. <br /> 4 . <br /> 14. Special Handling Instructions andAdditional infer ation Project Number 17382_-1 Document It. D208413 <br /> 1 ) 1811813 ADY- <br /> U # «r ! Z <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and arcumlely described above by the proper stdpputg name, am are classified, packaged, <br /> marked and labeled/placarded, and aro in all respects to proper conditicn for Irenspori according to applicable hrtt:rnaiienatand national governmonlal regulations. If export shipment and I am the Primary <br /> Exporter, i certify that the contents of this consignment conform to the terms of the allached EPAAcknuv0edgmenl of CCnseN <br /> I certify (1101 the waste nmunozation statement identified in 40 CFR 262.27(a) (if I am a large, quantity generalo•) or (b) (III am A small quanlity generator) is true. <br /> Generalor'slOfleror's Priniedrryped Name Si into Mtonth D y Year <br /> ,y . <br /> 1G. fliernalionai Sit pmants <br /> R ❑ Import to U.S. ❑ Expert from U .S Port of enirylexit: <br /> z Transporter signature (for exports only): Dale loan ng U. S .: <br /> w 17. Transporter Acknov4edgment of Receipt of Mlaleria`s <br /> iTransporter 1 Pnnl d(Ty red Name Si mature s ( ton . D w Year <br /> 1 . <br />€ zp : ^ maZl�r' Llure Month Day Year <br /> wc10. Discrnp0ncy <br /> 18a . Discrepancy Irdicafon Space ❑ ❑ ❑ Full Resection <br /> ❑ ouanhir Type Residue Partial Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S . EPA ID Number <br /> J <br /> LL <br /> U <br /> Facility's Phoc:a: <br /> LU 18c. Signature o6 Allemate Faeilily (or Generator) Plonih Day Year <br /> a <br /> Z <br /> 19. Hazardous Waste Report f0anagement Method Codes (i.e . , codes for hazardous waste treMment, disposal, tend recycling systems) <br /> 2. <br /> 20, Designated Facitily Owner or Operator Certification of receipt of hazardous materials covered by the manife except as noted In Item 10a <br /> Printed/Type(I )me Sig rdun M , rh Day Year <br /> i <br /> EPA Form 8700*22 (Rev. 12- 17) Previous editions are obsolete. I) EN 11161H) FA011., 1TY ' 0 LhA 's (14ANII�ES I' SYSTUI <br /> i <br />