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Please, print or type, (Forn1 designed for use on elite ( 12-pitch) lypiewliter.) FormAWoved, OMB No, 2050-0033 <br /> UNIFORM HAZARDOUS ' rcnenh W t r ter 2. Page t of 3 Emergency Rco <br /> esrtse Phone 4. Manifast Tracking Number <br /> WASTE MANIFESTt :=. t ;l r {l :'s . t .:i t3 0 1 7 7 9 1 2 0 8 JJ <br /> 5, Generator's Nama and `.ta:i'ng Address Generato(: 9d(,.# Atlrtri ss Of diffetcntthan m>tk, g NdMss) <br /> si Ia' L! IQLY ? `:' ' <br /> 1 " <br /> , Is ) ;ECT LANE <br /> r3L� <br /> aVI r'd'St� l ) rrrLf EtL _iP } v <br /> Generators Phone: t )., ,' , 3? I ' .�'.•' a : „H c. ;? ; , <br /> 6. Tran,-puder 1 Company I IamS U:S• EPA ID Numhar <br /> D 0 2 8 2 7 7 0 3 G <br /> 1. Triespatler 2 Gonxruty Name U.S, EPA iD Number <br /> WORLDWIDC RECOVERY SYSTEA4 INC. � r A r ,o 0 0 1 7 r, .1 <br /> 8. Designated Facility Name and Silo Address U.S. EPA ID Number <br /> YLIiv)A <br /> yr: LLC <br /> 2730 E 13TIl ST <br /> YUMA AL 59365 AZR000515924 <br /> FacillTyfsPhone: 400at0:t1n ceeo❑ <br /> ga. 9b, U.S, DOT Description (including Proper Shipping Name, Hazard Crass, ID Number, 10, Containers 11 . Total 12, Unit 13, Waste Codes <br /> Hof and Pecking Group Of any)) h'o. Type Quantity ZAWi.Nol. <br /> 1' NON- RCRA HAZARDOUS WASTE, SOLID ( OILY SOLID , PAPER Fit rERSI <br /> 0 � r <br /> Dill P t . <br /> Z 2LU . <br /> I <br /> 3. 1 <br /> t <br /> r <br /> 1 <br /> 14, Special Handling Instructions and Adc0cnel Information <br /> EMERGENCY CONTACT : CHENTREC 1-800-424-9300 WOES TERMINAL: CERES CS ' PROFILE N 981 ; 162G23NRSJIF%676 OILY <br /> SOLID, PAPER FILTERS " APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT �� ; , <br /> C) 0 '7 3 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of 'his coasigrimeM are fully and accuratrdy descnbed a'aovo by Met proper shipping name, olid are classified, packaged, <br /> marked and labelediplacarded, and are In all respects in proper condition for transport according as app foible international and national yam,, vernmenta! regulations. If exportshipment end I am tha Primary <br /> Exporter, I certify that the contents of Ibis consignment conform to the terms of the attached EPAAcknaviedgmerd of Consent. <br /> I certify that the waste minimization statement Idanfi€ed in 40 CFR 262.27(x) Of I am a large quantity generator) or (b) (if I am a areal) quantity generator) is true. <br /> Denoctnty."£rttero 'sprinIeffA� - Name t +� <br /> Signature lienh . Day Year <br /> -r 16. InternaGona Stupmenls <br /> ❑ bacturt to U.S. ❑ Export from U.S. Port of entrylet it: <br /> z - <br /> — transrarlersrgnatura (for exports anly): Date fearing U.S.: <br /> 17. Transporter AccnauledgmentofReceiptofNateriats; <br /> Tiansf-oiler 1 PfF1t+'_ - ! y <br /> Sign hton <br /> v <br /> �CL F . ` <br /> " r '' <br /> 2 Trans e 2 p�0tr175,px dyf m y� <br /> Signature MonE r Day Year <br /> 18. Discrepancy ! <br /> 1Ba. Discrepancy Indicalion Space Quantity t_l Type u Residue El Padiai Rejection L 1 Full Rejection <br /> Manifest Reference Number, <br /> 18b, Alternate Facilily (or Generator! U,S. EPA D Number <br /> J <br /> `v <br /> LL Faaf+tys Phone: <br /> w 18c. Signature of Allernate Facility (or Generator) Month Day Year <br /> ~¢ <br /> Z <br /> 19. Hazardous Waste Report Management Method Codas (i.e ., codas for hazardou> u,ste tre2tmomk disposal, and recycling gistems) <br /> 0 7 2. 3, 4. <br /> 20, Desrgraled Fa i ty O neror Operator: Certification of receipt of hazardous matesals covered by the man'fesl exceid as noted in Item 18a <br /> 16 <br /> Prnte(iZyped Nan Signature Month vaJ Year <br /> EPA Form 8700.22 (Rev. 3-05) Previous editions are obsolete. F(CILI`f '3 TO DESTINATION STATE (IF FIECit,$IRED ) <br />