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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST JJ K <br /> 5 Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> PAUL WIZ TRUCK04G W <br /> 4740 E. PELTIER <br /> AC.AMPO,CA 95220 <br /> Generator's Phon-}cam <br /> 6 Transporter 1 Company Name U.S EPA ID Number <br /> J cCARfAx072Yn <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> WORLDWDF V1 1i Ge• T1`4 S <br /> 8 Designated Facility Name�nd Site Address U S.EPA ID Number <br /> YU#AA YES ktAS i r- r KAbiSrtr% ii-A. ILI I`. AZR000521146 <br /> "DID US HK*WAY 95 <br /> YUMA AZ 85365 <br /> Facility's Phonet,• <br /> 9a 9b.U S DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit <br /> 13.Waste Codes <br /> HM and Packing Group('any)) No Type Quantity Wt rvol. <br /> 1. <br /> o" 4004--RCRA►MZARD"IS WASTE;ROUD,Afk" EWS RIPER C$t ..; :Pn F 352 <br /> PIt TFRS&DEBRIS <br /> z 2 <br /> L <br /> C7 <br /> 3. <br /> 4 <br /> 14 Special Handling Instructions and Additional Information <br /> 4'ROFIL"1633i'.61*R6----FlIII ER FILTERS ERG*171 <br /> EMERGENCY C(WrACT: WKE I ,1 }} `'—7 I <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations,If export shipment and I am the Pnmary <br /> Exporter,I certify that th 3 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 I am a large quantity generator)or(b)(if I am a all 0 tity generator)is true. <br /> Generator's/Offerors Pnnted/Typed Name T� Signature -�, . M Days Year <br /> �Z <br /> .j 16.International Shipments <br /> Il- <br /> ❑Import to U.S. ❑Export from U.S. Port of entA.? Transporter signature(for ex carts only) Date leawng S.: <br /> 17 Transporter Acknowledgment of Receipt of Materials <br /> 11— Tran I nted/Typed ame Sign Month Day Year <br /> CL <br /> S/`% / I <br /> cnMonth Da Year <br /> Z Transporter 2 /Typed df <br /> $ignatu y <br /> -all <br /> 18 Discrepancy t <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U S.EPA ID Number <br /> J_ <br /> U <br /> LL Facility's Phone Month Day Year <br /> W 18c.Signature of Alternate F 3cility(or Generator) <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 2 3 4 <br /> 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br /> Pnnted/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(R6v.12-17) Previous editions are obsolete. I D NATED FACILITY TO GENERATOR <br />