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Please print or type.(form designed for use on elite(12 pitch)typewriter.) <br /> Form Approved.OMB No.2050.0039 <br /> t.Generator rD Number 2.Plea 1 or 3.Emareamy Response Mons 4.Manifest Num <br /> ber <br /> UNIFORM HAZARDOUS i gC0 4249300 0 18 3 JJ K <br /> WASTE MANIFEST CAL 0 0 0 2 1 8 4 9 0 "6MW rsss rank the^waffli ~ <br /> 6, nerowee erne sed M-0M dm- <br /> TRUCK LUBRICATION-TRU033-PARENT <br /> P.O.BOX 1222 CA 92868 523 W.LARCH <br /> ORANGE TRACY CA 95304 <br /> Generator's Phone: 209 833-3409 U.S.EPA ID Number <br /> 6,Transporter 1 Company Name CAD 0 2 8 2 7 7 0 3 6 <br /> WORLD OIL ENVIRONMENTAL SERVICES <br /> U.S.EPA ID Number <br /> 7.TrakisWW 2 Company Name <br /> WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 017 5 4 2 2 <br /> S.Designated FadidyNams end Site Address U.S.EPA ID Number <br /> YES MANAGEMENT, INC. <br /> 6500 U5 HIGHWAY 95 <br /> YUMA AZ 85365 A Z R 0 O 0 5 2 114 6 <br /> Facili s Phone: <br /> 8b.U.S.DOT Descipdm pnduding Proper Shipping Name.Hazard Ctass.ID Number. 10.Contalners 11.Total 12.Unit 13.We*Codes <br /> HM and Padklrkg Group Of am)) No. Type Qua" WtNol. <br /> NON-RCRA HAZARDOUS WASTE,SOLID(PAPER FILTERS) _352 <br /> DM <br /> 3. <br /> 4. <br /> 14. H&WM9 ingrucam and Additional inlorma6on <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424.9300 WOES TERMINAL:CERES CS NAERG#961:171 *PROFILE#981: <br /> 162623NRSTRU033 PAPER FILTUS * *APPROPRIATE PPE EQUIPMENT��i <br /> �' <br /> 15. GENERATOWSIOFFEROWS CERTIFICATION:I hereby dedare that the contents of this mend are fu6y and akxxrat*described above by the proper shipping name and are deas(8ed,packaged. <br /> marked and iabdedfplacarded.and are in all respects U proper condition for transport acceding to applicable intema Gnld and rkatiorlal governmental Mgutetio M If export shiprnerd and 1 am the Primary <br /> Exporter,I certify that the contents o1 this consignment conform to the terns of the aftacled EPAAdnowiedgment of Consent. <br /> I certify that the waste mUimbation statement identified in 40 CFR 262.27(x)(g 1 am a targe quantity generate)of(d(61 em a small quantity generator)Is true. Mom Day Year <br /> Gen eslOffaWs Printedrlyped Nana Signature <br /> 6 / <br /> .r 116,International Shipments O import to U.S. -1 Export from U.S. Port of antrylexd <br /> tTransporter stgnsture(for expdr%only): Date leaving U.S.: <br /> 1% 17.TransporterAd nowledgment of Receipt of Materials <br /> Tran r 1 PrintedRyped Name Signature Me1th Day Year <br /> b <br /> .Ta ZAll <br /> M. sebc T Day Year <br /> T-1, <br /> 2 Prtn yped Mott<11 <br /> ,Y ' <br /> 5z <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Qui, ❑Type 0 Residue ❑Partial P.J.W. 0 Full Relactlw <br /> Manifest Reference Number <br /> U.S.EPA t0 Number <br /> 18b.A6emets Fadl6y(or Generator) <br /> v <br /> u�- Facilitys Phone: Day Yew <br /> LO 18c.Signabue of Alternate Faddy(or Generator? <br /> Q <br /> s <br /> N19.Hazardous Wage Report Management Method Codes(Le.,codes for hazardous waste Ireetnrertl,disposal,and racyding systems) <br /> � 1 12* <br /> 3, 4. <br /> jtql <br /> 20.Designated Facility Owner or Operator.Certification of ratalpi of hazardous materials covered by the manifest except as noted U item 188 <br /> Pent Name <br /> 9&k� ('!bvcuv� -- - I <br /> EPA Form 8700.22(Rev.3.05) Previous editions are obsolete. U DESIGINATED F I 1 TO DESTINATION STATE(IF REQUIRED) <br />