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....: <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator 10 Number 2.Pago t of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000181286 I 1 1-888-785.7225 012285180 FLE <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Advanced Industrial Coatings <br /> 950 Industrial Dr <br /> Stockton, CA 95206 <br /> Generators Phone: 209-234-2700 <br /> 6 Transporter 1 Company Name U.S.EPA ID Number <br /> Advanced Chemical Transport Inc./DBA ACTENVIRO CAR000070540 <br /> 7 r mip.wt r2Com ny Name U.S.EPA ID Number <br /> orldvvide itwecovery System, Inc CAR000175422 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Yuma YES, LLC <br /> 2730 E. 13th St AZR000515924 <br /> Yuma, AZ 85365 <br /> Fad,Vs Phone: 928-344-9828 <br /> ga, 91h.U.S.DOT Description linctuding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13 Waste Cotler <br /> HM and Packing Croup(ff ani No. Type Quantity Wi <br /> I. on- azo our este So id(Dried Paint) I CIF JZPJ 291 <br /> 0 <br /> lDL/l <br /> z 2 <br /> w <br /> c0 <br /> 3. <br /> 4 <br /> IC Special Handling Instructions and Additional lnlor bon Project Number 173827 Document# D208413 <br /> 1) 1811813ADY- x.L� J <br /> O itr S/Z <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I herebydedare that the contents of this coragnmord am fully soul accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iaboleciloacanded,and are in all respects in proper condition for transport according te applicable Internationatand national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I call that the contents of this consignment conform to the terms of the attached EPAAcknmNedgmenl of Cement. <br /> I cartity that the waste minimization statement identified in 40 CFR 262.27(a)(if am a large quantity generaloq or(b)(if I am small quantity generator)is hue. <br /> Generators/09erors PrintedRyped Nam r 5'gnalufa Month i Year <br /> J X <br /> 16.liburnational Shipments <br /> � ❑import b U.S. ❑ExpM tram U.S. PaM1ol enuylexiC <br /> ? Transporter signature(for exports onty): Dale lowing U.S.: <br /> JJ <br /> 17.TmnspwterAdmovdedgmenlof Receipt of Materials <br /> Transporter 1 PrintedR d Name Sign�atu/re/�///] on DAy Year <br /> 0 MTQ-Go m pe Name Si lure Month Day Year <br /> Gc 2O If <br /> i18 Discrepancy <br /> 181 Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility for Generator) U.S.EPA ID Number <br /> U <br /> LL Faclii Phone: <br /> W 18c.Signature Of Alternate Facility(or Generator) Monty Day Year <br /> Q <br /> Z <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> wo 1. I Z 3. 4. <br /> 20.Designated Facillity Omer or Operator:Certification of receiplof hazardous materials covered by the mi except as noted in Item Igo <br /> Pdnleaulme Sig alar Day Year <br /> EPA Form 8700. 2(Rev.12-17) Previous editions are obsolete. DES[ NAT FACILITY TO EPA's e-MANIFEST SYSTEM <br />