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ROSS prinl or type.(Form4esigned for use on elite(12•p4h)typewriter.) Form Approved.OMS Na.2050-0039 <br /> UNIFORM HAZARDOUS r Generator ID Number 2.F.-ige 1 of a.emergency Response Phone - A9an.- Tracking Number <br /> WASTE MANIFEST CAD 9 8 2 3 5 6 9 41 1 (800)424-9300 018526820 JJ K <br /> 5.Generalor's Name and Mailing Address Generator's Site Address(if different than maiPng address) <br /> MAXIM CRANE WORKS <br /> 2313 E. MARIPOSA RD <br /> STOCKTON CA 95205 2375 E MARIPOSA ROAD <br /> Generator's Phone: 209 464-7635 STrOCKTON CA 95205 <br /> 8.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA 117 Number <br /> WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 <br /> 6.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMCNT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 A Z R O O 0 5 2 114 6 <br /> Facl6 s Phone; (P24)344-9828 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contalners 11.Total 12.Unit 13.Waste Codes <br /> 11M and Packing Group(II any)) No. Type Quantity Wt fVol. <br /> x 1-NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) 352 <br /> 7 DM 7Da P <br /> W <br /> W 2. <br /> C7 <br /> 3, <br /> 4 <br /> 14.Special Handling Instructions and Additional Information S3012-4/9 <br /> EMERGENCY CONTACT:CHEMTREC 1-800-4249300 WOES TERMINAL:CERES CS *PROFILE#98l:16 623NRSMAX602 <br /> OILYSOLID,PAPER FILERS* *APPROPRIATE PPE EQUIPMENT <br /> 2 2�1 7 X Ste` <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION. I hereby declare that the contents of this cons!gninent ale fully and accurately desorlbed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport according to applicable international and national governmental regulations.If export shipment and)am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmant of Consent <br /> 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. <br /> rVOIfemes Printadffyped Name 'i7n ;ra Month Day Year <br /> -a 16.1ntemawnal Shipments <br /> f— ❑Import to U:S. ❑Export from U.S. Bort of entry/exit: <br /> Transporter 4naNre((oraxpMs ally), pate l"Pg U.S. <br /> 17,TrangpotlorAcknow"nienl of Raccipt of Materials Al <br /> TrahSOonnledfTyped oma+ 5egnature Month Day Year <br /> dr . <br /> a "I.— Q Z—( 1 <br /> Q Transporter P WWTyped Nlamp <br /> "sipn;lur � Month Ray Year <br /> 13.fltseraAancy <br /> TSa.Discrepancy Indication Space ❑ ❑Full R jection <br /> Quantity Type ❑Rasldua Partial Rejection � <br /> Manifest Rsference Number: <br /> 18b.Alternate facility(or Generator) U.S.EPA ID Number <br /> C.1 <br /> u- Facilitys Phone: <br /> cl <br /> Uj 180.Signature of Alternate Facil ty(or Generator) Month Day Year <br /> LIDQ <br /> 2 <br /> 19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 2, 3 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedrrypadNama Signa!ur Monde Day Year <br /> l.1 <br /> EPA Form 8700.22(Rev, -051 Previcuseditions Ara rbsolmo- I)EA GNATS f ',L ITYTO DESTINATION STATE (IF REQUIRE©) <br />