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# t I <br /> Form Apptovad OMB Na. 60 0439 <br /> P164'0 print ar i pe,(Fofn 0Vgnad for usa on elite(32 ttcfi}lypew�It;lr j <br /> UNIFORM HAZARDOUS- I.Get4hrp10t I i Ntim6er- 2 Rag91;o1 3..t=a�ergeacy Respan�o Phage ::Rlan Jasl Traaking Num ei � <br /> r WASTE MANIFEST <br /> CALb.QQ3.85005 aQ0 424=J 40: - �U UO--. Ji1'. <br /> i 5,Ganaralars"Name and.h1aI111ig Addias4 Generator's Situ Address(I.dlfforanl than M011 100 00630. <br /> PREMIE RYUNbA-DF TRACY-PRE346 <br /> 480'NAOUE R'O <br /> FtAOY: CA 95304 <br /> Danuralai'9 p.)iona:. 200,'020-3550 - <br /> TtOspottor,,i MpanylJama. PA D.Numbar <br /> WORLD OIL EM(IRONMENTAL SERVICES t C A D 0 2&2 7..7.0 3 6 I. <br /> -- ... US VAID urob9r <br /> 7 Tr •s�prt$r:2 Cartp9nY. arils `_ ` <br /> i W61O L*D`E rfkOOVERY SYSTEM INC. C A(7 0 0.0 3 T5 4:2`2' <br /> e P$algnated Factiity Ns-iia and We Addrea4 <br /> YES�ANAG ME, <br /> IIYC�. I <br /> 1$130 US HIGHWAY Or) <br /> IYU'MA° Az 853:65 AZR00052114.6 <br /> fact}itya f=irons, - <br /> 9b.U.DOT f3escifpiton(including proper Shipping Name,•Hazard Class JO N€rhbsr 10.Con;alnera -_-. Total 12,Untl. <br /> 9a; 11 i$.Waste Cndes,' <br /> and Racking Group(if any)) No. Type �ivartllty 4^(t:Nal: <br /> t f <br /> k>a; WwRCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) 52 <br /> i <br /> ` DIM P <br /> Al Z <br /> 4. <br /> • <br /> Y; <br /> 3,. <br /> , <br /> I . <br /> : <br /> u <br /> 149Aacia 9ftdling nsiiuc€Idnsan Adrfl.11ana,l0fatm@l.an € ' <br /> MER ENCYE*3NTA' <,CI1ENITA110 x-800-424-9304 WOES TERMINAL:CERES CS *P ,.I"4LE# tai 6 23Nfi3PR��46? <br /> OiLY50L.',IQt PAI' ,FILIEt�S* ":APPROPI�IATE`PPEEf�UIf'MEfVT ' SS <br /> ' �;" 8rA dbe19€e lllatlltk) nteniS allhla canslgnmeRl are(I illy aCfd#OIOty:d93CdhBd;a6ova by!114';Alopor:Shlpping nama:aiid ara:ctasslfied#pa9kkigetl, <br /> ts5; GENFft4tORSlOP6ERORSCeRTIFICATtOfJ.t1t ay <br /> madcod 0}si1 la4elndfp�iiar`dad,and are in all raspects.in proper condluon for franepoillsc;ordiag[;applicable lotsrnagonel and nallonal governmental regulations:If export sfiipment 9nd f:em Eho Frl#ttary i <br /> Eltpgltgf t;CeUItY tits lho c§ Itjnls ar(hls eonslgnmenl wnform to the terms of Itfe attached EpAAanQwletlgmant aI Gonsonl.: <br /> Iceriffy:ihallaW.as;o rtlhtltjzpllonstatamanlfdentltied'1n40CFR2fi2;27(p}(tflattla;largequantilygpnetelar�or(bj(Ifla s-.srr191Fuanlityg9n$fblor�.lsirue, <br /> _ gn era ; : h onlh <br /> tarslOffA,rar Pdnte Ilypad-Name Day, Year <br /> , <br /> pJ 16 lnterlS s>iorta.'- 1pm 1s'. Q lmporl to U-01- <br /> .S ❑ xPE;tr <br /> oAly) am U.S: ortar - <br /> ry _. <br /> U.a1e;1A tJ S"# <br /> s <br /> Transporter 1paatu"re_,(for.ajrp4rls -- <br /> i7r14apspgdaF., p�adg*4tofRooelplofMat6dals re <br /> T t OP s 1 p4mladlfyFe Nam 5t <br /> gpalu } Monih o�y � eat I <br /> - <br /> month, Day, <br /> 'n epv ar a �A S. <br /> ' <br /> 1 ' e <br /> / ar <br /> 1 ;btScreVara9: - �. -- <br /> ❑full Re <br /> 1�-Discrepancy Indication S ace El 1 <br /> P ❑ Quanlily ❑Typ9 ❑Residue " Pe€Ilel Re]eclipn J9ctloh I <br /> �, `h�andeat Rarerence Number U�EPA N m <br /> a ( <br /> lab,Allowto Fkllity(ar[Sanarotor) <br /> i <br /> 4 Flai4llyeph4ne r <br /> __ Mon11!" Day Yaac' <br /> -18c,Stgnatureof- larnato- itylot0M <br /> e.19f <br /> - _ - <br /> 19;.HazardousvfastaRepaanagainc4tMelhot3Cortask)9„cad9afotttoaetdeuslvaste(rgalmani,tit__spasbl and:recysiingsystelns}„ <br /> 1 2 _ - <br /> 3, <br /> 70—D asrgnnled Faclilly Coner or Operator:Cedipcation of reaefp3 of}tptardouaioalanals rgvered by the manifestexcapl as noted in Ham 199 <br /> Mon. D9 ea <br /> 3rilnladC <br /> ed•07- <br /> i. <br /> `• <br /> EPAFq 3 0022`(Rep, aq Provloiis:e lw60raobstitefe; DESl[,W#;D P'AGILITYTO lj�$T Av.0.0 STATE(IF REQUIRED) <br />