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V <br /> 11 <br /> T 2 a „ <br /> Please print or type Form Approvetl OMB No.:205QL0039. <br /> UNIFORM HAZARDOUS 1 Generator ID Number.'- 2.Page 1 of 3,.Emergency Response Phohe 4 Manifest Tracking Number /'�p C <br /> .WASTE MANIFEST CAD(129G03703 h` - 1 :20464-l3,'2i r 0 U 1 A J., 2 f G B F <br /> 5.Generators Name and Mailing Address Generator's Slte Address(If differentthan mailing address) <br /> STANLEY ELECTRIC MOTORS <br /> 1520 E MINER <br /> S`OCKTON,CA 96265 <br /> Generator's Phon2,09-464- 324 <br /> 4 <br /> 6,Transporter 1 Company Naive - U.S.EPA ID Number - <br /> f AMERICAN VALLEY WASTE OIL, INC. CAR000272302 <br /> 7,TransporI Company Name U,S.EPA ID Number <br /> Al RLDWlpERECOVERYSYSTEMSINC, CAMR175422.. <br /> 8..Deagnated Facility Name and Slte Address ". - - - U.S.EPA ID Number -' <br /> YUMA YES 2 WASTE TRANSFER FACILITY AZRi700521146 <br /> - 8500 US YIIGMAlAY 05 <br /> YUMA,AZ 85366 <br /> Facilitys Phone;}g(�34d-B :&- _. <br /> gy,. 91%U.S,DOT Description(including Proper Shipping Name Hazard Class,ID Number, - 10,Containers 11 Total 12.Unit 13.Waste Codes <br /> - NM and Packing Group(If anly)) - No. Type. Quantity Wt.11. <br /> 1 <br /> F NON-RORANAZARMAJS WAS IESOLID, PLIABLE GREASE 1 DM 220 P 3S2 <br /> 0 <br /> 4 <br /> 74.Special Handling.Instructions and Additional Information - - - - - - --- <br /> PROPILE#163'130i PLIABLE GREASE ERG;E 171 <br /> EMERGENCY COtf=T:DAVID <br /> © <br /> 15 GENERATORSIOFFEROR'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 Iabolodlplacarded andare 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 lcerjifythat the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. - <br /> !``I cerhfythat the waste minimization statement identified in 40 CFR 262.27(a)(if l am a large quantity generator)or(b)(ifI am a small quantity generator)Is true. IT <br /> Generators/Offerors PrintedfTyped Name. - Sign'eR/ Month Day,. Yor <br /> t <br /> 16:In ernational Shipments a7 - <br /> pm 1-1 Import to U.S. q ❑Expodfrour . Prdi of entry/exit <br /> Z Tfanspodera`ighalure(for exports only):, Date leaving U.S., <br /> W 17.TmnsporterAcknowledgmentofReceipt ofMaterials <br /> - <br /> Transporter nted(Ty ed Name ,,A. Signature Month Da - .Ye r <br /> Z Tran parter2 P i 6drrypedNarne <br /> (� ign ure /Mor1tIT Eli' e� <br /> 18:.Discrepancy <br /> 18a Discrepancy Indication Space Quantt II�� II``II <br /> r y, 4Tyyge Reetdu¢- �- ,.yJ Perjial,RPJechon, J_,I,FUII Refection' <br /> .i Manifest Reference Number.. <br /> 18h.Alternate Facility(or Generator) - U.S.EPA ID Number <br /> LLFacility's Phone- - <br /> w 18c.Signature of Alternate Fadlity(or Generator) - - - Month Day Year <br /> 6 <br /> Z <br /> N19;Hazardous Waste„Report ManagejMlMelfiod CAQesfie codesfor hazardou's waste treatment disposal,and recycling systems) <br /> 2. _ 3 4. <br /> 20;Designated Faclllty bwner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18V, <br /> Pnnledlry ed Name 91�.. : Signatu�,tp\/J/`�,\,� ,.^., Month Day Ye r <br /> EPA Form 8700.22(Rev 1 - Previous editions are obsolete. <br /> ( DES ATED FACILITYTO GENERATOR <br />