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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 27: The following uniform hazardous waste manifest(0 1 8170049JJK) observed with a signed designated facility copy. <br /> T�- <br /> I Please pdnl ortype,(FIM designed forum on"N (12 rSh ler Frnm ApPnYied.OM13 <br /> UNIFORM MAZARDOU$ r r3enam4 1D Number - a.Ppetvl 3.Energ yRasp—Phone 4.Mmlhet Trachltq Nu W <br /> WASTE MANIFEST C A' toff.5 0 0 6 ]. !80014749300 01 F R 7�": JJK <br /> 5 G 01.Name arp Mels A.— Gerxnlus She AdtlRSS 4d dABrarn Nan maiMva adtlmsa) <br /> PREMIER HYUNDaRI OF TRACY PREJAO <br /> 3440 NAGLEE ROAD <br /> TRACY CA 95304 <br /> eenemlore Phone 209 8213,3550 <br /> 9.T, sr 1 Companyy Nam¢ V5.EPR ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES f,A D 0 2 8 2 l l 0 3 6 <br /> 1.TmnepoMr2Com, Name llS.EPM0 Number <br /> WORLD W IDE RECOVERY SYSTEM INC. CAR 0 0 0 1!5 4 2 2 <br /> B,Deal9n�elvd FeolNy NeMENT'Ile Admtaa U.S.FPA IU N4enber <br /> Yt5 N7ANAG£MENT.IMC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 8536h <br /> AZR000521146 <br /> Hacdi aPhoner (928)3a4-9829 <br /> 9e. 9h.U.5.D07 Didedpte lielduding Pmpar Shippirrp Name,HazanI Gass,ID Number, 1D ConUVlers 11,TOW12.UM1N 13.w`aete COdes <br /> HM and P.Wrl,G,oup(BeneA Ivo. TYPe 9uamtN WINd. <br /> a RON-KRA HATARDOUS WASTE,SOLID(OILY SOLID,PAPER FILTERS) 52 <br /> W <br /> W 2 <br /> 3. <br /> 4. <br /> 14-Special Handling Inslrudione end Adthdanel Infamwem <br /> FRGENCY CONTACT:CHEMTREC 1-6044249300 WOES TERMINAL;CEDES CS *PROFILE 0.902 1132623HRSPREI413 <br /> 'SOLID,PAPER FILTERS" •APPROPRIATE PPE EQUIPMENT <br /> 15. GENERATOR'SMFFEROR'SCERTIFICATION,Ihereq tledam U,ar Ne oonlenrsdtNis wnslgnmentam luny and eccumrey desulbed above bylM lxaper sryrpggrg name.ab ere aasadred.packaged. <br /> marketl and labeladlplawrdad,and are in all respetts in pmper pandr5on mr Sanspart according to applipble in1emaeona4and ne5pnal govemmenra}regula4ons.N export slnpment and l am the 4nmary <br /> Exporter,I comfy that the mme N of this ponsignmem{gnform m dreterms ofthe avadled EPAWnowladgmentof Conserv. <br /> I ally Net the waste minimization sialement idantifred In 40 CFR 262.77(a)(I l am a large guanorygenerator?drSf11 'amalulWi L72fty gerremw'l Is lrae. <br /> Generator rGffgods Pdnled1TypX Name 5i�nalura MwrN Dy Year <br /> 1 16Jmdmational 5hpments Olmport lo-LLS. ❑Export lmm U' Poll a onlryle>ut <br /> Trsnspoder signature(for exports only): Date leaving U.S.: <br /> w 17.Transpoaff knm'dedgrnenl of Receipt of MI <br /> 2 Transporter 1 Parts"I ryped Name signature i _ IMne+ gay Year <br /> Q rr;;n-.Voner 2 Poll Y. <br /> Name <br /> mom Um <br /> I¢ 18.Discrepancy <br /> 1 18a.Piacrapencyindimbon Space ❑Quanhty OTA. ❑Residue ❑Peft Ra)ectwn ❑FNt Rejecllon <br /> fill MmIlesl Relerence Number. <br /> f8h.Adlomafe Facility(ur Goneralor) U.S.EPA ID Number <br /> J <br /> U <br /> ua- Facility's Phone: L71 <br /> OVeal <br /> W <br /> Z19c.Slgnalure al Allamale Facility fur Generator) <br /> Z <br /> 19.Hazardous Waste Report Management Malhod Codes(l.e-,codeslor hazardous waste treatment,disposal,and 1eyding systems) <br /> Ito <br /> LU 1, 2 3 4. <br /> 20,Designated FacIII Owner or Operator Corllficaliurl of receipt of h92ardous matedal$tousled by rhe manilas!a%ceps as noted in Ilam lee Uw1h Day Year <br /> PrinledlTyped Name Signature <br /> EPA Form 8700.22(Rev 3-05)Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br /> JASON GAITAN, REHS Page 27 of 51 <br />