|
-� IIT'Il��I�I��lI►�rll�ll�l1IIII!llll�lll��IlIIII'IlIIl�IlI
<br /> -17e prir-1 or tyloo, orm Approved.OtivIa No 2050.003ig
<br /> UNIFORM HAZARDOUS ieiie'alor it)Numf.e, 2.Page 1 of 3-Emi Response P,=e 4.Manifest Tracki Number
<br /> WASTE MANIFEST GAL0004018tit I 877b772G-69 01N62746 FLE
<br /> 11 Genwam,,'s N-.jr,w lid Mail;ni,,Address c!vA;drass(ifolifferpri:1na,maiiing a„jrpsi
<br /> Marshalls #M0381 Marshall s#M0381
<br /> 2093650992 249 West Kettlemen Lane 2429 West Kettlemen Lane
<br /> Generator's Phone: Lodi, CA 95242 Lodi, CA 95242
<br /> 6.Transporter 1 Corroany Nam-11- "i's FP:,:,:%urlbef
<br /> St pr i ry c I . B I I y Wa 5 t 2 So I ut i n n s ri C MNS0001 10924
<br /> Worldwide Recovery Systems LAR00017542-21
<br /> 8 Desigri'e,1 FvSiiry Name a,o Site Address Yuma Yes, LLC U.S EPA ID Number
<br /> 2730 E. 13th Street
<br /> Yuma, AZ 135365
<br /> Facility's Phone: 0-2 8 64 42 0 U-i--fJ
<br /> 9a. 9b U.S DOT rjescrip(;ii 1;�c uJing Proper Shipping Name.-071'd Ca5s.!D Toi,ai 12 U-it
<br /> Ht,l and Pii Group of anv)1 11 Waste Codes
<br /> Q,;antity Vd,
<br /> 0
<br /> ce Non RCRA hazardo u s waste., solid (C on sunjer 3 DF 0IZZI408 P 33
<br /> a Products), 1
<br /> ---
<br /> LU
<br /> LU
<br /> Z 2
<br /> LLJ
<br /> Szecial Hanil n,Ins:,j.fions and Additional Information
<br /> I. 102339(CA State Regulated Solids)
<br /> I- ----
<br /> 5. GENERATOR'SIOFFEROR'S CERTIFICATION: I hw-: -1-- s or this consignment are fury describeaatove tii-re proper ship inq name,arta are, ,ack-a('!,-,
<br /> marked and Iabeledlplacardea.and are all rpspec,s i-c -,00rt according io applicable into frati,)-a•and.rational governmental regulations.If export shipment anc i iii the Primary
<br /> Exporter,I certify that the Po-tents of this consignment auached EPA Acknowiedgmentof Convent
<br /> certify that the waste mjnirr,:MIOI am @large q,,;an:;Iy generator)o!ib—i(ifl&,ri a small quantity generator)sirue
<br /> Generatoes/Offeror's Ponted.lTyped Name SignatureOn t—"f� Day Year
<br /> I ) !22f
<br /> A--6,Ne;^
<br /> if, Internationia!Shipmerit5
<br /> E.Import to U.S. t I Export from J S Port of entrylem
<br /> Z Trin,;p(,,rtP.r siqnat..rre Ifni"cons only)
<br /> It leaving U.S.
<br /> CX 1� irqrsp��riA::lrk -YRP.i:,,eqp!of Materials
<br /> LU
<br /> ans-.,orler'PirintedrTyped Nai-.� %ictith Day rear
<br /> 0 0- Kristopher Almanza 021 1112ol')
<br /> Z Transporter"Prnt is
<br /> Day Year
<br /> F-
<br /> F-
<br /> 18-Giscraparcy
<br /> 18a.Discrepancy Indication Space Quantity 1 Type ❑Partial Rejection ❑Full Rejection
<br /> Manifest Retrence Number
<br /> 18o Alternate Facility(or Generate,' U S.EPA ID Number
<br /> Z
<br /> U
<br /> LL Facility's Phone:
<br /> LOU 18c Signature of Alternate Facility(or Generator) Month Day Year
<br /> Z
<br /> 0
<br /> in 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> LIJ I
<br /> ffi I . 1 — 4,
<br /> K Cosignat -- 1 erl Fa Owria,or OD@rato,:Cerlifeation of receipt of covered by Vie excilas n,,x(,d in ftfi 18d
<br /> rote r yped SignatureI Nil h -Day —Year
<br /> CA (AWCAIJQ2 747
<br /> EPA Form 8700-22(Rev.'2-171 Previous editions are obsolete. NAIVED FAC11.11TY TO EPA's e-MANIFEST SYSTEM
<br />
|