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Pleaserint or type. Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1'G°naratw IO NumSer - ;:.Page t d 3.Emergency Responee Phone 4.Manifest Tracking Number <br /> . ._ EMANIFEST ,. , rr� -,n ; et qq 17791239 JJK <br /> 5 Generators Name and MON Address Gerrertofs SiteAddress(ddibrard dmn mading address) <br /> nnESTONE H35o""612 u-t <br /> 340 N. "ENI RAL AVE <br /> :RACY CA! .`95375 <br /> Genre Phone: 20q - <br /> 8.Transporter 1 Company Name U.S.EPA ID Number <br /> ASIBURY ENVIRONMENTAL SERVICES C ,,D u 2 6 2 ;0 <br /> 7.Transporter 2 Company Name U.S.EPAID Number <br /> WORLDWIDE RECOVERY SYSTEM INC. r n R 0 r Q 1 n 4?? <br /> e.Designates Facility Name and SheAddress U.S,EPAID Number <br /> YUMA YES LLC <br /> 2730 E 1.3'1'H ST <br /> YUMA ti 85313:: ALFt00051,5y^<=1 <br /> Facil' s Phone: <br /> thi 96.U.S.DOTDascnpeon(including Proper ShTWQ Name.HaraN Class,ID Nrarber, 10.ComNner 11.Tort 12.Ung 13.Waste Codes <br /> HM and Pasxing Grnup(fand) No. Tyce carr y WI.TML <br /> 1 <br /> NON-RCRA HAZADOlS WASTE,SOLID(NON-GONFORMING FILTERS) <br /> UM P <br /> a 2. <br /> w <br /> a <br /> 4. <br /> W.Speowl Hand]i Iasmwtions andAddtbnal Information <br /> 2X SS <br /> EFVIERGENCY Ci_4'4 iACT :CHEMTREC .'-800-4.->4-S OO WOE TEPMINAI-.CERES CS "?,PPROP R•ATE PERSON A L PI-i01 ECI JVL <br /> EQUIPMENT `EE _ :7F:LeiM2F <br /> 15. GENERATOR'S/OFFEflORS CERTIFICATION. <br /> I hemydedare Mal the contents of tltis mnsynm aaurtay tlasrxibed y Ne proper shipping name,and are tleeslfietl.padwgeq <br /> marked and NbeladlPlarardatl.are are:n aB respens m proper rnmirbn fa lrenspon asatlmg t ppgoebe r ationalaM nntl .remmantal rapulslaro.if export sttipmerd and l am the Pmnay <br /> Expator.l ci iy that the contents ofthisounsgnmem owform to the terms of Ne aOacAe:EPA edgm fComen' <br /> I caddy that the waste Wnim¢ation slalemem eentlfretl in 40 CFR 262.27(a)(if I am a log qu general or(o ; m small quantity ganeraloq u we. <br /> rte w0ee era'sWt Typed Nome _ re Month Day Yea,ar <br /> J <br /> 16.International Shipments <br /> F ❑Importta U.S. �JExpon i. .S. PorloleMy;edl. <br /> Transports;sgrralme(far exppns ony): Dole leaverg US.: <br /> C 17.TranspoderAcaardedgmenlof Receipt of Fria rials <br /> Trarspo Pdnte d Signature ' .,. ,. Month Day Year <br /> y Transpa^ar 2 primed Name Month Day Year <br /> ♦ IS.Discrepancy <br /> 18a.Discrepancy Indreaaon Spare C; O wmyr ❑Type ❑Residue ❑Partial Per ipn ❑Reil RejecUan <br /> Neneest Reference Number <br /> tae.Anemato Fee fly(a Genortar) U.S.EPA ID Number <br /> J <br /> V <br /> sai Factions Phare: <br /> lac.Signature ofAllomale Faciliy(or Genres) Month Day Year <br /> y19.Hazardous Waste Report Management Meemtl Codes(ia.,codes for haaartlaus waste aeahnan6 disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> Yu.DeaignatWFacay Owners Operabr.Ce6rtWtionolrceiptottr dousmalerWs covered by re manderstexcept Insisted In Item 180 <br /> 1 P typed NeneSgneue Month Day Year l• <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolew DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />