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Please print or type.(Fam1 designed for use on elite(12-pitch) pewllter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,MarrifestTracking Number <br /> WASTE MANIFEST CRD 9 8 2 3 4 3 2 5 3 1 (800)423-9300 018,531385 J J K <br /> 5.GSn,�r K6l�arp W$MIingAddnss Generators She Address Of different than mailing address) <br /> 5110 PACIFIC AVE <br /> STOCKTON CA 95207 <br /> Generator's Phone: @ 209 475-6528 <br /> 6.Tran odef 1 Compan'Name U.S.EPAID Number <br /> II ORLD 011.n2NVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.TraWORLDWI UE RECOVERY SYSTEM INC. u C A R 0 0 OEPA ID r1 7 5 4 2 2 <br /> B.Dpaled Facility Name and Site Address U.S.EPA ID Number <br /> W9 MANAGEMENT.INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 AZR000521146 <br /> Faciity'sPhone: (928)3444828 <br /> ga. 9b_U.S.DOTDesWptlon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 1llWaste Codes <br /> HM and Packing Group(darty)) No. Type Quantly Wt.N61. <br /> NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID,PAPER FILTERS) 352 <br /> n ..' <br /> DM r P <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling InsWctionsand Addluonal Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:•CERES CS *PROFILE#9131:162623NRSEA&U OILY <br /> SOLID,PAPER FILTERS* *APPROPRIATE PPE EQUIPMENT �f�/�� � s <br /> 15 GENERATOR'SlOFFEROR'S CERTIFICATION: I herebydoelarethatthe contends of Ibis consignment are fully and accuratelydescribed above by the prepershipping name,aM are classified,packaged, <br /> marked and labeLngplacarded,and are In all respects in proper condltlon for transportaccorllrig to applicable interna6dnal_and national governmental regulations.If exportshlpmentarnd I am The Primary <br /> FxpWer,I certify that the contents of this consignment Itachad EPAAcknowledgment of Consent <br /> I certify that the waste minirnixafi r an86ad in 40 CFR 262.27(a)[{I am a i rity generator)or(b)(f I am a small quanh'lygenerah:i fs <br /> Geneiatofsl06emes Prin Namo Signature MO& Day Year <br /> 16.International Shipments <br /> i— Import to U.S. ❑Export from U.S. Port of errfryroa <br /> Trampartersignature(for exports only): Date leaving U.S- <br /> 17 TraimpoderAcknovfiedgmant of Receipt of Materials <br /> LU <br /> ~R" Trans r t PiimledlTyped NameSig Month Day Year <br /> Z Transporter 2 PrintedlTyped Name Signature Month Day Year <br /> l— <br /> i8.fltscrep-ancy <br /> 18a.Discrepancy laftgon Space ❑ Quantity'• ❑Typej <br /> 0 Rasldue ❑Partial Re ectlon ❑Fuh Refection <br /> hfanifsstRe�renceNumber, <br /> 1Bb.Altemate Facaity(or Generator) U.S.EPA ID Number <br /> C.> <br /> W Farditys Phone: <br /> Lu 1So.Signature of Alto mato Facility(or GeneWZO A'onlh Day Your <br /> z <br /> N19.Haiardous Waste Report Management Method Codes CO..codes for hazardous vraste treatment,disposal;and recycliN systems) <br /> 0 1. 2. - 3. 4. <br /> 20.Designated FacdRy Owner or Operator Cer6fcalion of receipt of hazardous materials covered by the manifest except as noled'm Item 18a <br /> PrintedlTyped Name Signature Month Day ear <br /> EPAFom18700-22(Rev.3-05) Previous editlonsani obso!eta. DESIGNATED FACILITY TO DESTIMATION STATE(IF REQUIRED) <br />