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Form Approved. OMB No, 2050-0039 <br />ease print or type, (Form designer) for use on elite (12 -pitch) typewriter.) =�'".M;6 <br />fest Tracking Number �� <br />t. GeneratorlD Number 2. Page 1 of 3. Em_rganry Resporc((}}UNtFORA1 HAZARt)OUS (Sp0) $24UV DWASTE MANIFEST G A L p $ 2 $©aratc> s Sie Address (if different than maiing address) <br />5, Generator's Nome and totalling Address <br />n <br />DELTA TRUCK BODY SHOP <br />100 E TRANSPORTATION CT CA 96231 <br />FRENCH CAMP 209 983-2400 <br />Generator's Phone: <br />G, Transporter 1 Company Name <br />WORLD OIL ENVIRONMENTAL SERVICES <br />7, Transporter 2 Company Name <br />WORLDWIDE RECOVERY SYSTEM INC. <br />a. Designated Facility Name and Site Address <br />YUMA YES LLG <br />2730 E 13TH ST <br />YUMA AZ $586365 <br />Facilitys Phone; 929 34 9828 t0. Comafners <br />9a. eb, U.S. DOT Descdption (including Proper Shipping Name, Hazard Class, ID Number, No <br />HM and Pac ing Group (if any)) <br />I• NON-RCRA HAZARDOUS WASTE, SOLID ( OILY SOLID, PAPER FILTERS) <br />a <br />LU <br />L <br />2. <br />W <br />4. <br />CAD028277036 <br />:PAID Number <br />CAR00017542.2 <br />=_PA ID Ncmhor w <br />AZR000515924 <br />it. To+�;t. a Waste Codes <br />I <br />Quant <br />35-2- <br />D M ZSC> P <br />A. Special Handling mstrucaons enu Ammo ... <br />EMERGENCY CONTACT: CHEMTREC 1-800-x€24-9300 WOES TERMINAL: CERES CS * PROFILE # 9BI :162623NRSDELB34 <br />OILY SOLID, PAPER FILTERS* *APPROPRIATE PPE EQUIP ENT { 1,� C 20 <br />1yd <br />15. GEN ERATOR'SfOFFEROR'S CERTIPICA7lON: (hereby declare that the r:,nnlents of this consignmentare tatty and accurately described above by the proper snipping name, arcl aro classified, packaged, <br />marked and R'SIOFFlaboiadiEROR'S and are in all respects in proper re thaconditt th for transport according to applicable International and national govermnental regulations. If export shipment ano I am the Primary <br />Exporter, i ceriihj!hat the contents of this consignment conform to the larms of the attached EPAAcknowiedgmant of Consent. <br />i certify that the waste minimization statement identified in 40 CFR 262.27(0) (f I am a large quantity generator) or (b) (fit am a smelt quantity genaratorl is true. Month Day Year <br />Si na to v - ar <br />ner r'slOfferor'sPrintedlTypadName <br />i . International Shipments Import to U.S. rI Export from U.S. Pat of en[rylexil; <br />LJ <br />Dille U.S.: <br />Transporter signature (for expods cniy}: <br />17 TranspodetAckncwladgmantolRecoiptofMatedals cUn „s tdon[h Day Year <br />0. �2 1At/ °�"' " Math Day Year <br />z a mo <br />t d1 S;gnaiwe <br />Tr <br />r <br />18. Discrepancy <br />❑ Residua ❑ Penial Rejectim ❑ Foli ReJacllon <br />t8a. Oiscrepanoy Indication TYp Space quantity e <br />Manifest Reference Number: <br />n U.S. EPA In Number <br />18b. Alternate Facilily, (or Generator) <br />J <br />dMonth Day Your <br />mz. Fa4fay'sPhone: <br />LU 18c. Signature of Alternate Facility (or Generator) <br />19. Hazardous Waste Report Management tdethod Codas {i.e., codes for hazardous waste treatment, disposal, end rooycling systems} 4 <br />W 1 2 <br />o . <br />20. Destgnatetl cility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest e . i as noted in item 18a h Day MontYear <br />Signatt: a l I ` € t/l <br />Printe Ype Na _ ., r , t ,,I-1\ z A -t "I <br />EPA Form 8700.2 (ev. - ) revious editions nre o solele. D1";91C, ti ('17 D I` A1,' •. I Y O 0E.8 4'IIVATI 0N 9-fATE (11= F -IU tJIIli" <br />