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<br /> Please print or type. Form Approved.OMB No.2054-0039
<br /> U WASTE MANIFEST Page 1 of Phone 7,Manifest Tracking Number
<br /> NIFORM HAZARDOU 012497966 F L E
<br /> S.Generator's Name and MailingGe-erators Site Address differrtinarimNinia
<br /> A08torial s Secret 1144 Mic oria tees'ret#1144
<br /> 2094761963 4950 Pacific Avenue, Space 425 4950 Pacific Avenue
<br /> Stockton, CA 95207 Stockton, CA 135207
<br /> Generator's Phone.
<br /> 6.Transporter I Company Name U S.EPA ID Number
<br /> Stericycle Specialty Waste Solutions Inc iM1NS000110924
<br /> 7 Transporter 2CornparyName J S EPA IO Number
<br /> Worldwide Recovery Systems ICAR00005422
<br /> 8,Designated Facility Name and S,le Address Yuma Yes, LLC JS EPA IDNimper
<br /> 2730 E. 13th Street
<br /> Yuma, AZ 85365
<br /> Facility's Phone,92AGA28938
<br /> ga 9b.U.S.DOT Descriptiur,(in,,-uoinq P,coer Shioping Name,Hazard Dass ID NUrjtel % --cntai-ers 1 Tota' 12 Unit '3 Waste Codes
<br /> HIM and Packing Group fl'any; Type Quaniq vvt,Vol
<br /> Non RCRA hazardous waste, liquid (Soaps, I CF 00014 P 331
<br /> Lotions),
<br /> Z 2
<br /> LU
<br /> 3
<br /> 4
<br /> 14,special Handling rstm,!,ons and Add;t'04'al Informatior,
<br /> I 110902(State Regulated Liquids)
<br /> Wit)
<br /> 15. GENERATOR11OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping arre,and are classified,packaged
<br /> marked and laWealpsacarded,and are,n all respects in proper conditionfortransport according to applicable iltematioria,and national governmental regulations.If export shipment and I am the Primary
<br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAckrowledgment of Consent
<br /> 1 certify that ilia waste minimization statement identified in 40 CFR 262 27la1'if 1 am a large quantity generator)or lb)iif i am a small quantity 4enerator)is true.
<br /> Generator'strOfferor's PrintediTypeo Name sfgnaturS71' ;;'. f mcrith Day Year
<br /> Cl on,110AAI _o.f_Limite,
<br /> 102 105 J-019
<br /> 16 International Shpmenis
<br /> Import 10 U 5 ❑Export from U.S P"'.1 ut entry,ex I
<br /> Trarsportersig,)aturelfor exports Qily), Uate'ea-r,,-,g U S
<br /> 17 TiransporterAcknumedgmem of Receipt of ratenals
<br /> Transporter I Pn,,1edtTyced Name S gnatretMortil Day Year
<br /> 0
<br /> o- Kristopher Almanza
<br /> 102 105 doig
<br /> jE Transporter 2 Printed7yped Name S:gnalure, Month Day Year
<br /> 0&�I�L- 16?— 1 t2- 119
<br /> 18.Discrepancy
<br /> 18a.Discrepancy Indication Space Cuantity
<br /> Residue Partial Rejectro,. Ful Rejection
<br /> 18to Alternate Facil.iv(or Generator, U EPA ID Number
<br /> Facility's Phcne
<br /> LLI 18c.Signature of Altemate Fac ty lo,Gerera:orl Month Day Year
<br /> !;i
<br /> Z
<br /> (D
<br /> 5t, 9 Hazardous Waste Report Management Method Codes{i.e.,codes for nazarcous waste treatment,disposal,and recycling sys,ems�
<br /> LILJ I
<br /> :N LA 1 T
<br /> 20.Designated Fatiliti/Owrer or Operator Cent`cation of receipt Y hazardous rraleria s covered by the manifest excep.�,a-,",ed 1)Item 16a
<br /> HnnitisallyptcI 'ame Signature Month Day Year
<br /> b� A Lx CA
<br /> EPA Form 8700-22(Rev.12-17i Previous e d,bons are obsolete
<br /> Ott-`S I FACILITY TO EPA's e-MANIFEST SYSTEM
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