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Please print or type.(Form designad for use on elite I2•pilch)lypewnWr.) Form 1por-'md.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 MANIFESTCAD 9 819 6 7 6 8 0 1 (800)424-9300 017 6 9 6 216 J J K <br /> 5.Ceneralor's Name and Mailing Address Gorwmlw%Silo Addros^.(d ddteront Ihan malting address) <br /> STOCKTON DODGE INC <br /> 3333 AUTO CENTER CIRCLE <br /> STOCKTON CA 95212 <br /> Generaloes Phoria; 209 477-3656 _ <br /> G.TransWor 1 Compmry Name U.S.EPA ID Numtler <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Cornpnny Name U.S.EPA ID NufAw <br /> WORLDWIDE RECOVERY SYSTEM INC. CA 1100017 5 4 22 <br /> 8.170slryna[rd FarJ4ly Noma and Silo Address <br /> U.S.EPAID Number <br /> YUMA YES LLC <br /> 2730 E 13TH ST <br /> YUMA - AZ 85365 AZR000515924 <br /> Facility's Phone dd. <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers natal 12-Unit <br /> 13.Waste Codes <br /> HM and Packing Group(f any)) No. Type Quantity WINoi. <br /> w 1.NON-RCRA HAZARDOUS WASTE.SOLID(OILY SOLID,PAPER FILTERS) ) <br /> o D M 1 !i� P <br /> z 2. <br /> w <br /> t� <br /> 3. <br /> 14:S F.W K,-indGM WUucU.and Addilkwl tn&MLIQn <br /> EMERGENCY PONTACT:CHEMTREC-3.-800424-9300 WOES TERMINAL CERE9 6S *PROFILE#:991:16262SNRSST0621 <br /> OILY SOLID,PAPER FILTERS* *APPROPRIATE PPE EQUIPMENT <br /> 15. t3ENERATOWSIOFFERDR'S eERTMATION:I hgmby ded=that the malanls of this evrs:lgnrrxnlam h4 and acre ataf)Fdtewt6d bbovo by.Me prbwthippinp nasifo,od are dasrll[ad,ppdtugad, <br /> marked and labeledfplacarded,aad am.ln an resp ds in prvpaf condition for baaspad squx iing.to 9PPI]cablo Inlamuonalsnsi rlallonal 9mmammiar mgubkA,Ire*d sldpmwdand 1 am"Primary <br /> Exporter.1 certify That the contents of Ws wnslgmufnt saaromi m ftloans of tho auadtad EPAAdvoxlr rrerd of Consont. <br /> t terGfy Ihat tlreKasln minimUntion slafemenl IdenGfrdd>n 40 GFR28Y.27(a}(f I msse forgo rryan4lygonarelo�y 1 fluent ty.gonaralor}Is true <br /> 44,�ews Ogntadrryped Name Slgan Mom Day',- Year <br /> ra <br /> 38.International ShipmentsImport ❑Expprt.trum US, AMotonlryrokR <br /> - ❑ to U:S: <br /> 2; Transporter signature(for exports ordy): Date fesving 1J.$ <br /> 17.Transporter AdwMedgrnerd oT"t of Materlets <br /> Trans CaTyped N n% Slgru4lturo Montle 'Day Yogi <br /> 1 r o Irl <br /> sem-=franspatr- .-.._ g(�nature —\—I— Month- -paX-- <br /> F- <br /> Ya.PFir1kWTypd no- <br /> 18.Discropancy <br /> 18a.Discrepancy Indication Space 0 Quantity ❑Type ❑Residue ❑Partial Rejection El Full Re}Cdfon <br /> Manifest Reference Number: <br /> .10-Aftemate Faeifdy.(or.Gonerntor) _ ... U.S.EPA ID Number, <br /> J <br /> 3. <br /> Fac16y,%Phone: <br /> w ISc.Signakua cf Ahomale FadDly lot Goneratar) 6ienth Day Yaar <br /> a <br /> z <br /> 19.Hazardous Wasto Report Managomorl Method Codes(i.e.,codes for hazardous w este lreatment,OT;pasal,and mcy&g syalarns) <br /> o I 2. 3. A. <br /> r <br /> 20.Drsignalod FaciRly Owner or Operator.Certification of recelpl of hazardous materials covered by the manifest except as noted In Item 10a <br /> PrinlecVtyped Name 1 Signature Mortin Day Ywr <br /> _....._........ ......... <br /> �.. <br /> EPA Form 8700.22(Rev.3-05) Provious editions are oUsoleto. DESIGNATED FACILITY TO DESTINATION.STATE(IF REQUIRED) <br />