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Tease print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 2 6 413 2 1 (S0O)424 9300 016870123 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 711 MATERIALS INC- 711002 PO BOX 3191 MODESTO CA 95354 , 27 14 STAGECOACH Generator's Phone: 209 943"4730 STOCKTON CA 95215 6,Transporter 1 Company Name U.S.EPA ID Number WORLD OIL 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 01 7 5 4 2 2 8.Designated Facility Name and Site Address U.S.EPA ID Number YUMA YES LLC 2730 E 13TH ST YUMA AZ 85365 AZRO00515924 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WLNoI. 1 NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) [ 352 DM *� v � P Z 2. LU 3. 4-1 4 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT: CHEMTREC 1-500-424-9300 WOES TERMINAL,CERES CS PROFILE#9131:162623NRS711002 OILY SOLID, PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT r4-`'�®2�� Z-k 5S �" 15. GEN ERATOR'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 classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and 1 am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. n ator'slOfferor's PrintedfTyped Name .Sign ure Month Day Year Lj��, k!)I I �Jl 1 16.International Shipments F— ❑Import to U.S. ElExportfrom U.S. Port of entry/exit, _ K Transporter signature(for exports only): Date leaving U.S.: LLJ o= 17.Transporter Acknowledgment of Receipt of Materials � Transrl PrintedlTyUdNamie. Signature / Month Day Year a �, til �lr 1 Z Trans orter 2 Printe�yp Nae Signature Month Day Year 0rR -e �J 1 18.Discrepancy 18a,Discrepancy Indication Space El quantity ElType ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U u`- Facility's Phone: U0 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ® 1' 2. 3, 4. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTy ame Signature Month Day Year EPA Form 87 0-22(Re . -05) Previous editions are ob ole e. L)L--s 1N-`rEa) DES—NNA-1 1N S®rm1~ (1F w-aluiFi1~n1))