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Please print or type. Farm Approved.OMB No.2050.0035 <br /> UNIFORM HAZARDou5 1.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR000333336 1 209-649-7411 025752900 JJ K <br /> 5,Generators Name and Mailing Address Generators SEte Address(if different than mailing address) <br /> AGILE TRANSPORTATION INC <br /> PO BOX 58$ 11209 HWY 99 <br /> l.ODI.CA. 9524© LOD3,CA 95244. <br /> Generators Phone:�Q9-1349-7411 <br /> S.Transporter 1 Company Name U.S.EPA IA Ntmv'er <br /> AMERICAN VALLEY WASTE OIL,INC. CAR000272302 <br /> 7,Transporter 2 Company Name U.S.EPA 10 Number <br /> WORLDWIDE RECOVERY SYSTEMS INC CAR000175= <br /> 8,Deslgnated Fadlity Name and Site Address U.S.EPA 10 Nurnber <br /> YUMA YES 2 WASTE iRANSFER.f-r e111M'�'} +�-t�r ARZ000521146 <br /> 6500 US HIGHWAY 95 <br /> YUMA,AZ 85365 <br /> Fad1{ty's Phone: 928-344-982$ <br /> 9a. 9b.U.S.OOT Description(ncluding Proper Shipping Name,Hazard Class,10 Number, 10.Contalners 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI-Nol. <br /> a 1. 352 <br /> ICON-RCRAHAZARDOUS WASTE SOLIDS,ABSORBENTS&OIL, 2 DM 360 P <br /> 0 PAPER FILTERS <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> 14,Special Handling limuchons and Addidonat informabon <br /> PROFILES 22102008NRS PAPER FILTERS ERG 171 <br /> EMERGENCYCONTACT:GAGE <br /> �Z.aS <br /> 15. GEN ERATOR'S10FFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeWIplacarded,and are in all respects in proper condition for transport according to applicable International and national governrrrental regulations.If export shipment and 1 am the Primary <br /> Exporter,l oertify.that the contents of this consignment conform to the terms of the attached EPAAcimowledgment of Consent <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a)(K1 am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generoesiolfer s PrintedRyped Name Sig? ft9 ( y Year <br /> _j 16.International Shipmen <br /> ❑Import to U.S. ❑Exportirom U.S. Porto exiC <br /> E Transporter signature(for exports only): Data <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> T Print yped N0 ae Mf [7�y Y <br /> 4 <br /> 0. <br /> Transporter Name Signature Month Day Year <br /> r <br /> 2- <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Refemnos,Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> a <br /> V <br /> LE Facility's Phone: <br /> Lu 1Bo.Sgnatnre of Alternate Faairy(or Generator) Month Day Year <br /> Q <br /> 2 <br /> N19.Hazardous Waste Repm Management Method Codes(i.e.,codes for hazardous waste treatrnent,disposal,and recycling systems) <br /> 01. 12- 3. 4. <br /> HNI <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifestexoept as noted In Item l9a <br /> Printed/Typed Nam Signature M Da ea <br /> Y ' <br /> EPA Form 8700-22(Rev.12-17) Previous i5arls arb obsolete: DISI. TED FACIL TD EPArs e-MANIFEST SYSTEM <br />