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Please print or type.(Form designed For use on elite(12-pitch) otivriter.) Foran Appr ovvd.OMB No.21750.0039 <br /> UNIFORM HAZARDOUS 1.Generator iD Number 2.Page 1 of 3.Emergency Response Phone 4 Manifest Tracking Number <br /> WASTE MANIFEST CAD 9 819 6 7 6 8 0 1 (800)4249300 01.7 7 912 2 8 J J K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> STOCKTON DODGE INC <br /> 3333 AUTO CENTER CIRCLE <br /> STOCKTON CA 95212 <br /> GeneralorsPhone, 209477-3668 <br /> ............... <br /> 6.fransporiar 1 Company Name U-S.CPA J3 Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7-T=,,padar 2 Company Name U.S.EPA 10 Numbor <br /> WORLDWIDE RECOVERY SYSTEM INC. C A R 0 0 0 2 7 5 4 2 2 <br /> 8.Designated FaciG)y Name and SilcAddross U.S,EPA ID Number <br /> YU MA YES LLC <br /> 2730 E 13TH ST <br /> YUMA AZ _ 85365 AZR000515924 <br /> Facllity/s Phone: o <br /> ga• 9b.U.S.DOT Description[ncluding Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11,Total 12.Unit <br /> HM and Pacidng Group(dariy)) No. type Quantity WLNOI,. 13.Waste Codes <br /> 0 1'NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID.PAPER FILTERS) 352 <br /> D M Ito P <br /> x Z <br /> 92> <br /> 3, <br /> 4, <br /> 14,spmca[HandNgInaf/uetiorrs.and rnkntrstfon <br /> EMERGENCY CONTACT.:CHEMTREG,x:$004249300 WOES TERMINAL CERES CS *PROFILE;ft 9s1:162623NRSST0627 <br /> OILY SOCID;.PAFER F1Tkhb'* *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT /.�ES <br /> 15 GENEFLITQR'SIOPFFROWS CCRT)F1CATION;I}raroby ticclam tlwt tho:conie 7b of dila rcradgnmonl am fully and n ratuiydasar@red abovaUJby thflvlprop�rstdppirfQ noma,aril ala dassdied,t 9 <br /> marked and latra(MVgc tdod,and aroh al mspocts In prvporcandifron fortrampart according fo epp;=W JnWavowAd national vvammonta#regt>ta am If mart shipdgant and I am circ Primary <br /> Expa*I onUty t)it ft ooriton&c4 ft oarr4nmerdwr&r i to the!Dans of the attached EPAAcknordedgnnznS of <br /> I cowry got i11a*;ulm Mklimizatlon alatemanlldonBBed In 40 CFR26W(a)(if I am a largo gumr8tygenr:rator r ismall quantity ganeralxr is baa, <br /> cr al06daPs NwedlTyped Name S a Irc Month Day 'hw <br /> 21 IF <br /> -J 15;International ShlpmenLw <br /> f= ❑Import to.U.S. ❑Expert from U.S. Isom of entry/A)il: <br /> Transpoder signature'(to'exaorts'only): Date leaving U.S.: <br /> w. 17.TranspottecAdmawiedgrwt.of Reca$of•fdalbr ah <br /> Tans 1 Priatrd/fy d Na Slgnplum 5 Dray! Yrra l <br /> I.? I�. <br /> d Transpow 2 Pr[nteWyp&lT <br /> mo Signalum Nlanul pay Year <br /> H <br /> 18.Otscrcparwy <br /> 18a.Discrepancy Indication Space ❑ CfUanllty ❑Type ❑Residua E Parflal Rejection ❑Full Rejection <br /> M,nnifest Reference Number. <br /> 18b.Altemato Facility(or Generator) ;,ti.,>, U.S.FPA ID Number <br /> 3 <br /> U - _ <br /> Facility's Phone: <br /> � 18c.Signaturo of Allornato Facility(or Generator) Month Diy Year <br /> d <br /> z <br /> rrn <br /> 19.Hazardous Waste Report Management Method Codes(Le„codes for hazardous waste treatmonL disposal,and recycling systems) <br /> LU <br /> 1. 7. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materlals covered by the manifest except as,noted In Item 18a <br /> PrinlodlTyped Name Signature Month Day Year <br /> EPA Form V00-22 tRev,3.05) P'rovidus adilion.are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />