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Please print or type.(Form designed for use on eilte(12-pitch)typewriter.) Form Approved.OMB No.205070039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Number <br /> E WASTE MANIFEST A t3 CI�?. 7 t3 3 �a �63C) 3�14 `�' <br /> 5.Generator's Name and MailinAddress Generator's Site Address(if different than"mailing address) i <br /> FIRESTONE �>5&612 t <br /> 40 N,UNT L AVE <br /> . • <br /> TRACY <br /> CA 95376 <br /> Generator's Phone: . 209 221-7164 <br /> 6.Transporter 1 COMMame,` U.S,EPA Ip Number l <br /> URY E tR rdMFKTAL SERVICES dr AD 0 2 8 27 7 0, <br /> 77ransporter 2 Corn any Name : U,S.EPA ID Number <br /> WORLDWIDE RECOVKRYSYSTEM INC. C A Ri?CY 43 64�"`2 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YUMA YES LLC <br /> 2730 E 13TH ST <br /> YUMAAZ; 861636 <br /> AZRPO _ <br /> Facility's;Phone: } ��$ 3 f 11. <br /> „1 <br /> 9a. Pb.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)) No. Type Quantity Wt.NoL 13.Waste Codes <br /> 0 1:NOW-SORA t DOU x WASTE.SCROD(NOI N•s Nk��F 6�iNG FIL7E6��») 2 .,:. .. j 3 <br /> A <br /> 4M P <br /> 2 <br />' <br /> ;1 <br /> 4: <br /> 14.Special,Handling Instructions and Additional Information <br /> G E'$ E'Et41 "Y'�r4J1�4FG :'s$ iA�Tfii, ' =363 «".< 3 Y $ ltfiQ+11: riE1` '�° $$� 3i7E;"' ti ' itTr't6� <br /> QtJ9P�ENT E i ENCY CONTACT Cts WCT-4247 <br /> �47 r UCK PROFILE 0 3,61623NRSFIR669 <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 governmentalregulations.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 statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I a a s generator ' ,ue� { <br /> Generator's/Offerors Printed/Typed Name 1 1 ) Signature Mont Y <br /> 16.International Shipments <br /> Z ❑Import to U.S. ElExport from U.S. Port of entry/exit: <br /> Transporter signature(for expottsonly): Date leaving U.S: ' <br /> Y r w 17.Transporte.rAcknowled9,ant of Receipt of Materials <br /> Transporter 1 PrinteNTyped Name $ignattire"'. r Mont ay. Ye i! <br /> Ay <br /> - <br /> Tr s cPrinted/Ted NameS�patur - <br /> r�gryMon h ' Day ar I <br /> a <br /> 18 Discre ncy L w <br /> 18a Orsctepancy Indication Space <br /> _+ <br /> 0 QuarltitY :❑Type ❑Residrfe, ❑Partial Rejection ❑Full Dejection <br /> Manifest Reference Number: t <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> um C) <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) MonthDay Year f <br /> 7 <br /> 19.HazaYdous W stet eport Management Method Codes;(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ; <br /> 2. <br /> 20,Designated Facility Owner or Operator:Cert i kation of receip f hazardous materials covered by the manifest except as noted in I m 184. <br /> PrintedTTyped Name a Signatuure Month D Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. ®ESiGNATE® FAClLITY,T® GENERaT®R <br />