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i <br /> 1 <br /> E <br /> Form Approved.OMB No.2050.0039 j <br /> Please print or", 2.P' Olaf <br /> 3,FmergentyRttsponsa PttOne 4.1Manifeat Trarkl0g Namber <br /> UNIFORM HAZARDOUS 1•GatarataIDNtarbar 208-Alf-84.'iB GBF <br /> WASTE MANIFEST CALO0033fJf38B <br /> 5,Generators Nems and Mating Address Generators Bite Addross Id ditteranl al6u meliing ed fees <br /> ZUCKERMAN FARMS ARGONAUT <br /> PO BOX 487 1030 S.ARGONAUT <br /> STOCKTlON;CA 95201 STOCKTON,CA 8520@ <br /> Generators Phonar.09-471-8438 <br /> e.TronsWler i Company Name U.S.1 t'AID Number CAFi0DA272302 <br /> AMERICAN VALLEY WASTE 0)L,INC. <br /> 7,Trdn3poder2 Canpany Name - - U.S.EPA ID Nur*r <br /> WORLDWIDE RECOVERY SYSTEMS INC CAR000175422 <br /> a.Designated Fadly Noma end Site Adds 41.5.EPA ID Number <br /> �YUMA YES 2 WASTE TRANSFER FACILITY AZR000521148 w <br /> 0500 US HIGHWAY 95 <br /> YUMA,AZ 85365 ` <br /> FecdEt7e Phone928-344-9826 <br /> 9b,U.S.DOT Deaaipaan(ndudrng Proper Shipping Namn,Heard Class.ID Number. 10.Conlal- 111.yQua�A 1�L 13,Waste Cotles <br /> HM and Paddng Group[darty)) No. Type <br /> 1' NOIS,RCtZA HAZARQOU3 WASTE SOLID,ABSORBENTS,PAPER OIL <br /> 12MP 52 <br /> FILTERS&DEBRIS ) <br /> /sof <br /> W 2' <br /> C) <br /> 9, <br /> 4. r <br /> r - <br /> 14.Spadal Handling Ins7rt*ms and Additional Irdormallan <br /> PROFILE#`�LU LT)I 1\)-01,� PAPER FILTER$ ERC#171 <br /> EMERGENCY CONTACT;'TREY <br /> 15. GENERATOR'810FFEROR'SCERTIFICATION:1ltereby dedare that the eonlent6 of Ws oomsi n"M afa ful y and e=mtaly described above bytho proper slippw name.and are classified,packaged, <br /> marked and labofedrplacarded.and aro In a&mpeela In proper mom W Vanap0rtaooardkrgi0applkaMa krtema8anal and eel«+atgavemmanial regrdatbne.lf exporlshipment and I am the Primary <br /> Exportac I ear*that ane oonionis of this mAinamt conform to the Lerma of the saadned FPAAeWrosn rnonl of Gond <br /> I ce:afy that the waste mfNmlxatlon daiament kis WOW In 40 CFR 262.27(e)Of I am a tarps gtmbty ganerak4 or(b)(dl am a amen quantity 9erreratD0I5we. Day, r <br /> GeneratorelbaaWs Med'TYW Nares IgnaAse <br /> ,7& u -SID L7''k— t--I <br /> 18.International Shtpmants ❑Import to U.B. ❑Export fm m U.S, bdof 046yo* <br /> Trane er ilgnalym(for exports art): Date feat3ng U.S <br /> 17.TmnspVWAdmv,Nodgmsnl of Recelpt of INeldlais Algalh i)ay' Year <br /> Transporlsr P ems no M In <br /> '9 1F & <br /> 18. <br /> uflisom m q <br /> 18a,Dlscrapaney ke aWn Speoe ❑ Q".My ❑tape ❑Resn ❑Penial Re)ac4lon ❑FWl Rejection <br /> Man><es1 Ref6rertce Ntmthor: <br /> Iob.Aeemate Fedaly(or Generator) U.S.EPA 10 Number <br /> v <br /> FadWs Phone: <br /> Day <br /> i51gnaluraof rnatoFadlq ofi3shem1w hWn <br /> 8aear <br /> t9.HazerdcuaWasteReportfAanagamentMaltssadCodesQ.a.cadeatorhezerdouavrpstateetmon4Elapoael,endtecydtngayatems) <br /> G 1. 2. <br /> 3. 4• <br /> 20.Des grmtad Faclly Ovmef a Operator,Cer66catton of loos t of hazardous maiodels covered by the malltM except u naiad In Ilam 18a <br /> printa ro lh Day Year <br /> EPA Fo 00.22{Rev.12.17)Pfovtous&Mors are 013601810. JE-6—IGINTrED FAc ITY TO CPA'$e-MANIFEST SYSTEM <br />