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Please print or type. <br />A <br />re o 1-a ce <br />z W <br />0 <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1 Generator ID Number <br />CAL000194471 <br />, <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />(800) 424-9300 <br />noun /Approver]. uivits IVO. ZUOU-UUn <br />4. Manifest Tracking Number <br />020372 7 Sri JJK Generator's Name and_ moog Addresi; <br />SERVICES INC CEN644 <br />Generators Site Address (if different than mailing address) CENTRAL VALLEf WAS E <br />P.O. BOX 241001 <br />LODI CA 95241. 1333 E. TURNER RD ** SEE NOTES FO <br />Generator's Phone; 209 333-5655 1 LODI CA 95240 <br />Transporter 1 Company Name U.S. EPA ID Writer WORLD OIL ENVIRONMENTAL SERVICES 1 CAD0282770 36 <br />Transporter 2,Comparp Name U.S. EPA ID Number <br />- ovel\/ .11(tt,..A- S I aitovor6L f rt. <br />Desig <br />YUMA <br />nated FaciNy Name and Site Address f U.S EPA ID Number YES, LLC <br />2730 E 13TH '-',T <br /> <br />YUMA AZ MiNM <br />i AZR000515924 <br /> <br />Facility's Phone: (928)344-9828 I <br />93. 9b. U.S. DOT Description (including Proper Shipping Name. Hazard Class, ID Number. 10. Containers 11. Total 12 Unit <br />NM and Packing Group (if any)) No. Type Quantity Wt Nol, .13. Waste Codes <br />NON-RCRA HAZARDOUS WASTE, SOLID (OILY SOUDS) <br />w 0 1 <br /> <br /> <br /> <br />Special Handling Instructions and Additional Information <br />EMERGENCY CONTACT: CHEMTREC 1-800424-9300 WOES TERMINAL: CERES CS NAERG# 951 : 171 * PROFILE it 981: <br />162623CEN644 OILY SOLIDS * *APPROPRIATE PPE EQUIPMENT <br />1 ,)e f I <br />GENERATOR'SIOFFEROR'S CERTIFICATION:. I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, aid are classified, packaged, <br />marked and labelediplacarded, and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations. If export shipment and 'am the Primary <br />Exporter. I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if lam a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Generators/ erors Printed/Typed Name Off i . <br />A/r AC-. \ k-ILNIA U \ (colt 5 <br />Signal Month Day Year <br />r-T—Ct---- --7 V' __ - • --- ,—.....--.___ —....,„Ez 1 2 4 e.......) <br />_i <br />'I <br />.. <br />International Shipme a <br />Import to U.S. Export from U.S. Port of entry/exit fl <br />Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER Transporter Acknowledgment of Receipt of Materials <br />Transpo rinled/Typed Nfime t Signature /i---- Month Day Year <br />/---e Z.__ ' "-----. 44 / I ,-----,2,_ —I-12 12 5 1 z 7 Transporter 2 frin)ed/Typed Name / ,, Signature Month Day Year <br />.6tou-r tia I <br />,,. „_. <br />I 1 1 7 1 7 ) FACILITY ---4- Discrepancy <br />182. Discrepancy Indication Space LI Quantity Type LI Residue LI Partial Rejection Full Rejestion <br />Manifest Reference Number: <br />1 8b. Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I *- DESIGNATE 18c. Signature of Alternate Facility (or Generator) Month Day Year <br />Hazardous Waste Report Management Method Codes ji.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1 2. 3 4 <br />Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br />----- <br />Printed/Typed Name Signature Month Day Year I _ . <br />I I,,_t <br />I <br />e .i <br />_ , ._ ._. _ . - L4 1 i I ' i I <br />orm - ev. - revious editions are obsolete. DESIGNATED FACILITY TO GENERATOR