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Form Approved . OMB No. 2050.0039 Please print or type . (Form designed for use on elite (12•pitch) typewriter.) 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4,, Manifest Tracking Number UNIFORM HAZARDOUS CAL 0 0 0 4 3 0 4 9 4 1 (800) 4249300 017696308 JJ K WASTE MANIFEST 5. Generators Name and Mailin Address Generators Site Address (if different than mailing address) CALIFORNIA AUTOSPORT 180 BUTTON AVE MANTECA CA 95336 Generator's Phone: 209 666' 7247 III III WIN I U.S. EPA ID Number 8, Transporter 1 Company Name CAD 0 2 8 2 7 7 0 3 6 WORLD OIL ENVIRONMENTAL SERVICES U.S . EPA ID Number 7. Transporter 2 Company Name WORLDWIDE RECOVERY SYSTEM INC , CAR 0 0 017 5 4 2 2 U.S. EPA ID Number 8. Designated Facility Name and Site Address YUMA YES LLC 2730 E 13TH ST YUMA AZ 85365 AZR000515924 Facility's Phone : (928)344-9828 1111111111111 111111 ga 9b. U.S. DOT Description (including Proper Shipping Name, H =ClNumber, 11 . Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) Quantity Wt.Nol. 1 , NON- RCRA' HAZARDOUS WASTE , SOLID ( OILY SOLID , PAPER FILTERS) 352 o /TD I P Z 2•UJ I WWII 3 _ w 14 . Special Handling Instructions and Additional Information EMERGENCY CONTACT , CHEMTREC 1-800.424-9300 WOES TERMINAL: CERES CS PROFILE # 981 : 162623NRSCAL1109 OILY SOLIQ, PAPER IFILI * APPROPRIATE PPE EQUIPMENT to 15. GENERATOR'SIOFFEROR'S CERTIFICATION : I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, applicable international and national governmental regulations. If export shipment and I am the Primary marked and labeled/placarded , and are in all respects in proper condition for transport according to Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement Identified In 40 CFR 282.27(a) (if I am a large quantity generator) ) i a small quantity generator) is true. Month Day Year Generators/Offerors Printedffyped Name Sign tur U IIIInj16. International Shipments ❑11 Import to U.S. El Export from U.S. Port of entry/exit: 2 Transporter signature (for exports only): Date leaving U.S.: 17. TransporterAcknovrledgment of Receipt of Materials Month Day Year JTranser 1 Printedflyad Nam Sign CL ltr 2 Printed ed Name r Sign Month Day Year 18. Discrepancy ❑ Residue ❑ Partial Rejecti n El Full Rejection 18a, Discrepancy Indication Space ❑ Quantity ❑ Type v ' Manifest Reference Number: U .S. EPA ID Number 18b, Alternate Facility (or Generator) J u` .. Facility's Phone: Month Day Year W 18c. Signature of Alternate Facility (or Generator) Z N19. Hazardous Waste Report Management Method Codes (i.e. , codes for hazardous waste treatment, disposal, and recycling systems) 0 1 2 31 4. 20. Designated cllity Owner or Operator: Certification of receipt of hazardous materials covered by the manliest except as noted in Item 18a MonthDay Year Printed/Typed a Sign re E EPA Form 8700 22 (Rev. 3m05) Prev ous editions are obsolete. ® ?SI �aNATFD FA V TO DESTINATION STATE ( IF RECIUIRED)