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Please print or type. (Form -resigned for use on elite ( 12-pitch) typewriter) Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST CAD 0 2 8 2 7 7 0 3 6 1 (800) 424-9300 0 1 8 2 3 6 6 3 0 JJ K <br /> 5, Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br /> ASBURY ENVIRONMENTAL SERVICES 1300 S. SANTA FE AVENUE <br /> 1300 S . SANTA FE AVENUE COMPTON CA 90221 <br /> COMPTON 310 886-3400 CA 90221 <br /> Generator's Phone; <br /> 6, Transporter 1 Company Namo U.S. EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES pCpApD 02 8 2 7 7 0 3 6 <br /> 7. Transporter 2 Company Name U.S. E G A �uBt O 01 7 5 4 2 2 <br /> WORLDWIDE RECOVERY SYSTEM INC <br /> 8, Designated Facifiry Name and Site Address U.S. EPA ID Number <br /> YUMA YES LLC <br /> 2730 E 13TH STREET <br /> YUMA AZ 85365-19 A Z R 0 0 0 515 9 2 4 <br /> Facility's Phone: (928)3449828 <br /> 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit <br /> 9a. f? ( 9 � PP g 13. Waste Codes <br /> HM and Packing Group (ii any)) No. Type Quantity Wt/Vol. <br /> 1 , NOWRCRA HAZARDOUS WASTE SOLID, (FILTERS CONTAINING OIL) D M ILZO P 223 <br /> 0 <br /> F- <br /> 2. 228� M1 <br /> 0 <br /> 3. <br /> 4. <br /> 14. Special Handling Instructions and Additional Infonnaijoq <br /> EMERGENCY CONTACT : CHEMTREC 1-800-4249300 * PROFILE # 981 : 081916 , 962 : 081916 * APPROPRIATE PERSONAL <br /> PROTECTIVE EQUIPMENT <br /> 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shlppj'j 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 regulaiions. if export shipment and I am the Pdmay <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgmenl of Consent. <br /> I certify that the waste minimization statement IdenUried 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 /> GeneratoeslOfferoes Pd yped Name Signaluro 'Month Da Year <br /> GAG <br /> 16: International Shipments Import to U.S. ElExport from U.S. Port of enlrylexiC <br /> Z Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. Transporter AcknorModgment of Receipt of Materials <br /> TransporterPdnt Name Signaluro Men r <br /> O <br /> ., {' Month Day ear <br /> Q Transporter 2 Pdntedrryped Name Sig alure <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ quantity El Type ElResidue ❑ Partial Rejection ❑ Full Rejection <br /> ManifestReferance Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> V <br /> u� Facility's Phone: <br /> on Day Year <br /> w loc. Signature of Alternate Faylily (or Generator) <br /> Q <br /> z <br /> 19, Hazardous Waste Report Management Method Codes (is., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 3. 4 , <br /> A 1 2. . <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdntodrlypod Name Signaluro month Day Year <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br /> r ' <br />