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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050A039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page i of 3.Emergency Response Phare 4.Manl(eat.Trao rtg amber <br /> WASTE MANIFEST CAL 0 0 0 218 4 9 0 1 (800)424-9300 01$5 31069 JJ K <br /> 5.Generator s Name and Ma91n Address Generatoes Site Address(d different then mafUng address) <br /> TRUCK LUBRICATION-TRU033-PARENT <br /> P.O.BOX 1222 5231Ai,(ARCH <br /> ORANGE CA 92868 <br /> 209 833-3409 TRACY CA 95304 <br /> Generator's Phone: U.S.EPA ID Number <br /> 6.Trans rter 1 Comp an Nama CAD 0 2 8 2 7 7 0 3 6 <br /> WO <br /> OIL ENVIRONMENTAL SERVICES <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Comfy Name <br /> WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 017 5 4 2 2 <br /> B.Designated FaclGty Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMENT,INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 AZR00052i146 <br /> Fecil .Phone: (928)344-9828 <br /> 8b.V.S.DOT Description(including Proper Shipping Name,Hazard Gass.ID Numbor, 10.Containers 11.Total 12,Unit 13,Waste Codes <br /> �• Quantity W A40. <br /> • <br /> HM acrd PacMing Group(if any)). No. Type <br /> o NON-RCRA HAZARDOUS WASTE.SOLID(OILY SOLID,PAPER FILTERS) 5 D M 52 <br /> 4a 660 P <br /> Z 2. <br /> W <br /> C9 <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional Irdormallon <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#981:162623NRSTRU033 <br /> OILY SOLID.PAPER FILTERS* *APPROPRIATE PPE EQUIPMENT () ) 4 5 x <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper slipping name,and are assifted packaged, <br /> madied and tabefedrptacarded,and ere In aU respells in proper condition for transport according to applimbie international and national govemmentei regulations.0 export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the woo minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)o9p)(it 1 am a small quantity generator)is true. <br /> GenerattoesfOHeroes Printedrryped Name nature Month Day eer <br /> s... N t G l 1r-a <br /> .J 16.International Shipments <br /> ❑Import to U.S. ExpoA from U.S. , Pat of entrylexii: <br /> Transporter signature=for exports only): Date leaving U.S.: <br /> 17.Transporter AdmowWgmenl of Receipt of M110" Month Day Year <br /> a Transporter i PdntedrTyped Name S 9 <br /> 4 - <br /> U) Printedriyped me STY '51 1Z <br /> / Month eel <br /> U 10 ' <br /> 18.Oisaepancy <br /> 18a.Di9orep Indication space quantity ❑Type 0 Residue Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 16b.Aftemete Facility(or Generator) U.S.EPA t0 Number <br /> 0 <br /> I Facials Phone: Mon9r Day Year <br /> 18c.Signature or Alternate Facility(orGenerator) <br /> a <br /> z <br /> 19.Hazardous Waste Repoli Management:Method Codes(Le.,codes for hazardous waste treatment,disposal,end recycling systems) <br /> T <br /> 1t 2. 3. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item t Be <br /> PftMWW No Signature n Day Year <br /> EPA Form 870022(Rev 3 Pravi u ditio s are obsolete. DmGN TED FAbILIfY TO DESTINATION STATE(IF REQUIRED) s <br />