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Please prir}(or type.{Farm deslgfted for use an eine(12-pitch)(ypavxilvr.) Form Approved.OMB No,2050-0039 UNIFOor l pe,ifo D0U5 1 Gfor user!D Nurrhar 2;Page 1 of 3.Emelgercy=Phunul6.Manifost Tracking Nunrbar WASTE MANIFEST CAL 0 o a 3 6 B 6 9 3 1 flop 017696 218 J J 5,Genwatcrs N4019 and Mailing Address Generators Silo Address(!f different than rnafling address) IMPERIAL TRUCK WASH AND REPAIR JAZZ GROUP 2142 W.YOSEMITE AVE JAZZ GROUP INC MANTECA CA 95337 Generators Phone: 208 0139 6111 U.S.EPA;D Murnher 8 Transporter i Company Name WORLD OIL ENVIRONMENTAL SERVICES CRD 0 2 8 2 7 7 4 3 6 U.S.EPA 1D Number 7.Transporter 2 Campaly Nrama WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 8,Designated Facility Name and Sfle Address U.S.EPA ID Number YUMA YES LLC 2730 E 13TH ST YUMA AZ 85365 AZR000515924 FacTtys Phone: ga 9b.U,S.DOT Description{in6u&ng Pfoper Shipping Name,Hazard Class,ID tvumber, 10 Conlairars 4t,Total 2.Unit 13.Wasie Caries HM and Paciring Group(If any)) No. Typo Quantity WI Nol. NON-RCRA HAZARDOUS WASTE.SOLID(OILY SOLID, PAPER FILTERS} D M X52 o p 3, 14.9pci 010 handling ImWctiuns and Addilionai 1n ormation EMERGENCY CONTACT:CHEMTREC 1-BOA-424-9300 WOES TERMINAL:CERES CS W PROFILE#981:162623NRSIMP072 1 OILY SOLID, PAPER FILTERS" *APPROPRIATE PPE EQWPMENT� S!3 15. .G ENERATOR'SIOFFEROR'S CERTIFICATION; I itareby deciara that the eontenls Of this coA4.11ment erefWly and 89cvralely described above try the proper ahlpping Hama,and are daclad,packaged, marked and IabefedfplaCafded,and are In«il respects in proper condition for transport according fo applfcahlainteMal;oisat and national governmental regolaliona.if expos etdpment and I am the Primary Exporter,}.certify that the contents of this conaignmant Conform to Ute Corms of the nt>arhed EPAAcknesvtedgrient of Consent. certify that the waste niinimization slalement ider H9d In 40 CFR 262.27(a).(if I am a kande gvanrdy generator)of(b)(if I am a smail ctoant(ty generator)Ie hue. GeneratoesiC orsPflntedfTypedName ..fgnature Month Day Year j 16.Interne cnal Shipments of on Elimpart from U.S. PM of Ll Import la U.S. Transporter signature(for exporia only): Odle leaving U.S.: ►r717.TransporterAcknovgedgrrsnl of Receipt of Malarial . Mcnih Day Year 11�— Trz rter 1 PrinlAdif?ped Name / 5' nature nnad/TypedName ignatt Month Day Y r ii 18.Dlwepan ��--11 lea.Di ancy indication space ❑ Quanli� lJ Typa ftesirive ❑Partial Re}ec4on ❑Full Rejection s hianifest Reference NUmber: 1 b,Altarnata Fadlity{ar Generator) U.S.EPA ID Number J U w Facililys Phone:. W 1ec.Signature of Atlernata Facikry(or Generator} Month Day Year 2 t8,Hazardous Wasle Report Management Welhoo Codas(i.e.,Codes Iar hazardous Waite treatment,dispogal.and racoirrg.systams) i 20,0eai naled FRCIIII Owner or Oparator.Ce01callon of receipt of hazardous materials 0115fed by the manifest excapl as noted In Nem 1801 pn re tali Day ear uct1uc� EPA Form 8700.22(Rev,3.05) Prevlous edfllons are obsolete. D SIGNATE FACliteY TO DESTINATION STATE(IF (REQUIRED)