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I <br /> No-ase print or type.(Form des(gnod for use on elite(12-pitcb)typewriter.) FormApproved.OMB No.2050-009 <br /> UNIFORM HATARE)OU 11.GeneratorIDNumbsr 2.Page 1 of 3,Emergency Response Phone 4.Mantfast TracIdng Nember <br /> WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 :1" (800)424-9300 017.4 6 6 6 0 2 JJ K <br /> 5.Gemmtoes Name and Maning Address Generators Me Address(1 diffarent then malirtg address) <br /> TRACY CHEVROLET-Q&M INC <br /> 3400 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Generator's Prone: 209 835-4500 <br /> 5.Transporter 1 Company Name U,S.EPA[D Number <br /> WORLD OIL ENVIRONMENTAL SERVICES C A 0 0 2 8 2 7 7 0 3,6 <br /> 7.€rang der 2 Company Name U.S.EPAID Number <br /> WORLDWIDE RECOVERYSYSTEM INC. CAR 0 0 O'1 7 5 4 2 2. P, <br /> S.Designated Fadity Name end Slo Addrasa U.S.EPA1D Number <br /> YUMA YES LLC <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 AZR000515924 <br /> Fadi s Phone: (928)344-9828 <br /> 99. 0•U.S,DOT Description(11%luding Proper Shipping Name,Hazard Class,ED Number, 10.Cenra Hers 11.Total 12,Unit 13,Waste Codes <br /> HM and Pecking Gmap(ifany)) No, Typo 4uanllty WlNgl. <br /> 1NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID,PAPER FILTERS) 52 <br /> a <br /> DNI P <br /> LU 2 <br /> w <br /> ti? <br /> -3. <br /> 4. <br /> 14.Special Handring instructions and Additional Information' <br /> EMERGENCY CONTACT,CHEMTREC 1-800.424-9300 WOES TERMINAL: *PROFILE##9BI162623N QAN001 OILY SOLID, <br /> PAPER FILTERS* *APPROPRIATE PPE EQUIPMENT � �� ��� � <br /> 15. GENERATOR'StOFFEROR'S CERTfFICATION: I hereby dodare that the contents of this conslgnmant are fully and accurately described above by the prapershipping name,and era classified,packaged, <br /> marked and tabetedlplacardod,and are in all respects In proper condition for transport according to applicable intemadonaland national govammental rogulaeons.if e>Epart shipment and l am the Primary <br /> Exporter,icar8ty that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I cer6fythat the waste mWmuagon statement identified in 40 CFR 262.27(a)of I am a largo quantity generator)or(b)(dl am a all grrontity enorator)Is true. <br /> neva rsfOtfaM(sPrtnladPT odName ig lura M Day Yoa <br /> 16.totemalloaal Shipments <br /> ❑Import to U.S. ❑ENA from U.S. Port of entr 100: <br /> Transporter signature(fat exports aniy); Date i v,ng U.S.: <br /> 17,Transporter Acknowledgment of Racei of Mafertsts <br /> ransporter ri i d Na Signature No Day Maar <br /> aa. <br /> dTr*nsTder2n9Pt edmo Signature Month Day War <br /> 4 <br /> 18.DIscrepancy <br /> 18a;piscfep"Indfoaffon$Paco El qw tHy Type ❑Residue ❑Parital ReJec#on ❑FUIi ReJecean. <br /> Manifest Reference Number: <br /> 16b.Alternate Fac€kty(or Generator) U.S.ERM0 Number <br /> i3 <br /> '4 Faculty's Rhona: <br /> Cl 180.5ignolurs olA temate Fadilry(or Generator) Month Day Year <br /> � e <br /> 19.Hazardous Waste Raport Managemont Method Codas p.a.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> i. <br /> H <br /> 3. #.1 -i <br /> 29.Designated Facility Owner or Operator.Cer0calfon of receipt of hazardous matadols covered by the manifostozcept as noted in Item 18a <br /> Print a We NM Day 70ar t <br /> Ei <br /> EPA Forrii 87000 22(Rev.3.05) Provibos editions are obsolete. DESIGN D FA IL,ITY TO DESTINATION STATE(IF REQUIRED) <br />