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-- III�I��II�NIII,{�NI�Ilillllllll'llll�l�llllll11�111 <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 <br />