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t <br /> l <br /> t <br /> lease print or type. Form Approved, OMB Na. 2050.0039 <br /> 1 UNIFORM HAZARDDUS i . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 3 3 6 6 7 6 1 (800} 4249300 023639275 JJ K <br /> 1 <br /> S. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br /> STORER TRANSPORTATION . ST0051 - <br /> j 3519 MC DONALD AVE <br /> MODESTO CA 9535&9770 1909 5 ARGONAUT STREET <br /> i Generator's Phone: 209 644-5114 STOCK ON CA 95206 <br /> l 6. Transporter 1 Company Name U.S. EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES C A D 0 2 8 2 7 7 <br /> 036 <br /> 7, Transporter 2 Com an Name U,S. FPA ID Number <br /> WORLD91 DI RECOVERY SYSTEM INC. C A R O fl 017 5 4 2 2 <br /> 8. Destgnaled Facility Name and Site Address U.S. EPA ID Number <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 AZR000521146 <br /> Facility's Phone: (928)344-9828 <br /> 98. 9b• U.S. DOT Description (including proper Shipping Name, Hazard Class, ID Number, 10. Containers <br /> 11 , Total 12 Unit 13. Waste Codas <br /> HM and Packing Group ('d any)) No. Type Quantity WWoI. <br /> 1 .NON-RCRA HAZARDOUS WASTE, SOLIDS (OILY SOLIDS) 352 <br /> a <br /> � DM I � P <br /> LU <br /> 2, <br /> 0 <br /> 3. <br /> 4. _ <br /> 14. Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT : CHEMTREC 1-800-424.9300 WOES TERMINAL: CERES CS NAERG# 961 : 171 * PROFILE # 9B1 : <br /> 162623NRSST0051 OILY SOLIDS * * APPROPRIATE PPE EQUIPMENTs- <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignmmnl are fully and aoWnitely described above by the proper shipping name, ant are classified, packaged, <br /> marked and labeledfplacarded, and are in all respects in proper condition for transport according to appricable international and national governmental regulations. lf export shipment and i am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAdkrwwtedgmenl of Consent <br /> I certify that the waste minimization statement Identified In 40 CFR 262.27(a) ('d I am a large quantity generator) or (b) (H I am a small quantity generator) Is bugs <br /> Generalor's/Otferors Printedrryped Name Signature Month Day Year <br /> r A42 C>7 C 7� <br /> 16, nlemat anal Shipmentsposse D Import to U,S. ❑ E <br /> xport from U.S.U,S. Port of entrylexil: <br /> 2 Transporter signature (for exports only): Date leaving U.S.: <br /> w 17. TranspoxterAcknowledgmeni of R ipt of Matos <br /> Ul <br /> Trans er i Printedlt'yped Name ( Signatu Mwdh Day _Year <br /> Z Transporter me d Name Sign Month Ray Year <br /> ZZ ly <br /> S8a aepancy Indication Space El Quantity Type ❑ Rewue ❑ partial RejectionI <br /> ❑ Full Rection <br /> Manifest Reference Number. <br /> 18b, Altemato Facility (or Generator) U,S. EPA ID Number <br /> U <br /> t<E Facifily's Phone: <br /> Lu 180. Signature of Alternate Facility (or Generator) MonthDay Year <br /> Q <br /> Z <br /> 0 19, Hazardous Waste Report Management Method Cotes (.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 14, <br /> 20. Designated Facility OwneW Operator. Certification of receipt of hazardous materials covered by the manifest except as aged in Item 18a <br /> I I i -twn ssssAif <br /> Printed[Typed Name PSignature Month Day ye ryear <br /> LL1 GL <br /> :PA Form 8700-22 (Rev. 1 T17) Previous eilitions are obsolete. D SIGNATFD IL1TY TO EPA's e•MANIFEST SYSTEM <br />