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Please pdrtt or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 3 6 8 6 9 3 1 (800)424-9300 O O JJ K <br /> 5.Generators Name and Mailing Address Generator's Site Address(If different than malting address) <br /> IMPERIAL TRUCK WASH AND REPAIR JAll GROUP <br /> 2142 W.YOSEMITE AVE JAll GROUP INC <br /> MANTECA CA 95337 <br /> Generators Phone: 209 239-8111 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 0 1 7 5 4 2 2 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 AZR000521146 <br /> Facility's Phone: (928)344-9828 <br /> 9a. 9b.U.S.DOT Description(induding Proper Shlpping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> and Packing Group(d any)) 13.Waste Codes <br /> HM No. Type Quantity WtNol. <br /> 0 IKON-RCRA HAZARDOUS WASTE.SOLID(PAPER FILTERS) C 52 <br /> IDM 50 P <br /> z 2. <br /> L <br /> C9 <br /> 3. <br /> 14.Special Handling Inst uctions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL CERES CS NAERG#9B1:171 *PROFILE#9B1: <br /> 162623NRSIMP072 PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT# aO 1 <br /> 1 x a5 <br /> 15. GENERATOR'SfOFFEROR'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, <br /> marked and labete#lacarded,and are In an respects In proper condition for transport according to applicable intemationaland national governmental regulat(ams.if export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAclmowiedgment of Consent <br /> I certify that the waste minimization statement Identified in 40 CFR 262 27(a)(d I am a large quantity generator)or(b)(d1 am a srrtag quantity generator)Is true. <br /> GeneratoNOffemes Pdntedrryped Name SignatureMonth Day Year <br /> x � d% <br /> 16.International Shipments <br /> Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Data leaving U.S.: <br /> LU <br /> 17.Transporter Admowtedgment of Receipt of Materials <br /> Transporter 1 Printedlryped Name Signature <br /> Month Day Year <br /> a rK 1,Ckex4% /10 <br /> Transporter 2PrintedlTypad Na SEgnatu Month Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity [:]Type ❑Residue ❑Partial Refection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> FaciTtys Phone: <br /> w 18e.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycrug systems) <br /> G 1. 2. 3. 4. <br /> u <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nrted ktarn 18a <br /> Pdnted/Typed Name Pa /`� ) <br /> Signature Month ay Year <br /> W % `1 <br /> EPA Form 8700-22(Rev.12-1 ) Previous editions are obsolete. DESIGN TE ACILITY TO EPA's e-MANIFEST SYSTEM <br />