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Form on No.20540039 <br /> Please print or type.(Forth(1e519neU tar use on elite(12 Itch)typeWriter.) 2.p t of 3.Emergency ResDoase PMne <br /> a an a umber <br /> 7C�WmtofftsN� <br /> SAROOUS t.Generarora)Number 018170136 JJK <br /> NIFEST C A L 0 0 0 3 7 0 3 9 6 1 (tSfl01 424 9300 <br /> ame end Mating AddmssTONE 8356612.CENTRAL AVECA 95376 <br /> Ymna: 209221-7164 Us.EPA ID Nwrmw <br /> . I ComPmY Memo CAD 0 2 8 2 7 7 0 3 6 <br /> WORLD OIL ENVIRONMENTAL SERVICES us.EPAtota;FW <br /> 7.Trenspwler 2 Compwry Name CAR 0 0 017 5 4 2 2 <br /> WORLDWIDE RECOVERY SYSTEM INC. <br /> U.&FPA ID Nan+bw <br /> 8.Dee'O W Rdrdy Name and SGeAddress <br /> YES MANAGEMENT. INC. <br /> 6500 US HIGHWAY 95 <br /> YU NIA A2 85365 AZ R 0 00521146 <br /> Fad s Phona: ! C <br /> 9a. 9b.U.S.DOT DesaiWca(=kd1fQ PqW SNPPIn9 tom,Hazard CWss,ID Number, No Containam 1)Wa tt.Tobf U.UNt 13.Waste Codes <br /> Qtsndry 1MMVd. <br /> HM end PaddrgGrowiii arM) <br /> cc: 1.NON-RCRA HAZARDOUS WASTE.SOLID(OILY ABSORBENT) ' <br /> o DM P <br /> z 2 <br /> w <br /> 3. <br /> 4. <br /> p <br /> td.SPedef NandbW msWctlmresMAdduiaal InhxmsDan (� 5yl ,-311+ <br /> EMERGENCY CONTACT :CHEMTREC }-800-424-9300 WOES TERMINAL: CERES CS NAERGrF 981 : 171 -PROFILE N 981: <br /> 162623NRSFIR669 OILY ABSORBENT * *APPROPRIATE PPE EQUIPMEN 3O6 dZ Z! l x ss <br /> 18. GENERATOR'BfOFFEROR'8 CF4iTIFFCAT10N:ihe+ebydedare Bat momn'snisands cw+al9nrnantare WYwdra�al*om abora by the <br /> ew"IRVWee,w4 and Prsra7 . <br /> madmd and bbeledrpb=*d,and nein a0 respects in pmper w am or transpata%wdeV leaWi=w <br /> Egotter,I CaNfy that the mnteab of Dds censgwrent mrerrn m the tames of the abedW EPAAdmW&*mmdat CM=L bfine. <br /> I=*Dot erew ee mrieftelbnsiatamem WsnFled iti 40 CFR 26221(a)(d l M a INW qwm*59 « d<Y tlenemar) Monty Day Year <br /> Gen rotsvwuxvlyp@d Name o6 t <br /> .� 16.Intomoft el SNpments Y_Sl ❑lmpwtto U.S. ❑wontmm U.S: of w"tedb <br /> Transporter slgneWm(for,wpft ow: le <br /> W npol <br /> 17.TryteeAWOWe4MM of RecdWal Mates Sgnaure Month Day Year <br /> K Transport N [ <br /> a t mute gar >tie <br /> Tmnsportw2P I ypadNsma ( 0--7119 <br /> f�r� <br /> ♦1 18.DisaspancY LJFua P.e)eacm <br /> I <br /> 1 1Be..Dmaepancyln6c&onSpeen ❑ Ouway ❑TW' ❑Residue ❑Padialftejecgon Manifest Rdw mNumber. <br /> U.S EPA fD Number <br /> 166.Aharrala Fadity(w Generate) <br /> J <br /> u Faatlys Pham: Momh Day Year <br /> 1&.SignaMeofAllerrate Fa'd8y(w Genemkr) <br /> 4 <br /> hta.Mazardoie Wade RePert Mana9emart Medved Codes(La.D)dBi for fame k'! i A:to eaaMem.dhWesaL and recy<ih�g aYarartu) <br /> w 1 2. 3. 4. <br /> G L-41 <br /> 20.Deslgrele4 FaaT7'Owner arOperatw:Cer6fxa8on of receipt oftuvaNws matedaSsaged by da man;"est exmptas Mad Mt�m tBa ay Year <br /> Prin "Nw G <br /> EPAForm8700-220545.OS) P vbuaeditronsareobsoleta. DESIGNAT FA L DESTINATIONSTATE(IFREOUIRED) <br />