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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.M'�Qlif t T g They{�(� <br /> WASTE MANIFEST C1AI..Or0028W9 1 888-785-7�a a����j � V 3 F L E <br /> 5.Generek Ys Name and Malling Address Generalor's Site Address 01 different Ilia ii mailing adctmes:.) <br /> DESP LTID <br /> 15 Mr irdW Meme <br /> Lathmp, CA 95W Generator's Phwie: -%-9125 <br /> 8 Transpoder 1 COm ny Name U.S.EPA ID Number <br /> ,\ft. Cre"Cel Traispod Inc./DBA ACTewro CAFOO 07OW <br /> 7" Ga name y est ' U,S.EPA ID Number <br /> VViDDRRda1vlllnl0o*�a! (;AJWW175472 <br /> 8.Designated Facility Nam and Site Address U.S.EPA ID Number <br /> Yuma YES LLC(Use EW# 19853) <br /> 7730 E. 13t� St AZR000515924 <br /> YLRna, AZ 85365 <br /> Facility's Phone: 192"4-91428 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 1.Non-lZURA naziudou5 Waste.Sold,(0111y aOMS) � LW YX � P 352 <br /> 0 <br /> z 2. <br /> w <br /> 3 <br /> 1 <br /> i <br /> 4 � <br /> i <br /> I� f_ <br /> k <br /> 14.Special fdandling Instrucfians and Additional.Informabn i'"swit NIrtFiW .UCf en ., l T <br /> 1) 176516 DRY- x'/ `` `�` IV <br /> �'�4. 'i�}•., <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping 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 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 EPA Acknowledgment of Consent. <br /> I certify that the waste minimization sraletpenl identified in 40 CFR 262.27(a)(if I am a large quantity ganeralor)or,(b){Ulama small quantity generator)is true. <br /> Generator'SiC7Heror's Prinled+Typed lfafneS�igr�alurs Month Day Year <br /> 16.Intematlonal shipments <br /> U Import to U.S. Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transperler 1 Pfkntedffyped N Signature }. Month Day Year <br /> U) Transporter Printed/Typed Name Signature Month Day Year <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type [-1 Residue LIPartial Rejection <br /> Full Rejection <br /> Manliest Reference Numbor. <br /> Alternate+Fad]Hy(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facilily's Phone: <br /> C3 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> F) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1, 2• 3 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Farm 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />