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3460 Naglee Rd. Record ID# PR0527345 <br /> 11/20/2020 Program: HW <br /> Photo 30: The following uniform hazardous waste manifest(018170049JJK) observed with a signed designated facility copy. <br /> Form Approved-OMB No.20Wo 0039 <br /> Pfaase pram or type.(Foran nesgned For rme m dke iz-plldl Y.Y <br /> I 1-C ab ONuw 2.Pa9e1M ),Emma REspo ea Phaw d, nrTacY n9N mbar ��� <br /> UNw 9TEWNIFESTug CAL000385005 1 1424,9300 018526708 <br /> s Uwnraeifa f�w faalhpadema Genemeora Sae Adems,la daferenf man mamrgadamal <br /> PREMIER FryUNDA1 OF TRACY-PRE146 <br /> 7480 NAGLEE ROAD <br /> TRACY CA 95304 - <br /> ceneremre Pnwre: 309 8263560 <br /> ®.Tmnapmyr 1 Camfxny Mama <br /> US EPA 10 Num4er <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2827 3 0 3 6 f <br /> ]immporh.2 DnWanY Name US.EPA r9 Numbx <br /> WORLDWIDE RECCVERY SYSTEM INC. CAR 0 0 61 7 5 4 2 2 <br /> e Das%.hd Farly,(la-.0Gib Adtlmsa u,S.EPA ID Numi <br /> YES MANAGEMENT.(NC. <br /> 5500 US HIGHWAY 95 <br /> YUMA AZ 95365 A Z R 0 0 0 5 2 1 14 6 <br /> FdPu 6ihWrM: 929 44-9929 <br /> ya. 9b US.OOTOeavpeonG dad.,pPNpar ShlppNg Hama,Hazam Clean,IO Norther, 16.Dordmnem 11.1aal 12.Wk 13.Wade Cades <br /> NM end Pacing GmuPldaay)) No I Type Ousnety veNd. <br /> �tiON it - "AZARDOU6 WASTE.SOLID(PAPER FILTERS) <br /> I D <br /> z z <br /> t� <br /> 3 <br /> 4 <br /> 14.Spedal bunds lnsWcims andAKdmal lnim Mm <br /> EMERGENCY CONTACT CHEMTP,EC 14100.424.9300 WOFS TERMINAL:CE RE CS _- 331:162623NRSPREI14,6 )� <br /> PAPER FILTERS`.'APPRC!PRlATEPEEXQUIPMENT <br /> 15. GENERATGR'SIOFFEROR'S CERTIFICATION:1 hereby ds dare Thal the mnfenfs of this consgnment are hilly and amumi described abmre by the proper shipping name.and are dam"".padaged <br /> adcod . <br /> mand labafedlpf—dad,and are In all respat�in proper omdrGon kr transport amoming k applicable inlamasonal and national govammental regulatons.IF export shipment and I am me Pemary <br /> Exporter,t cer*thatme confenls ofthis censgnmentmird m to the terms of theatta hed EPAAcknowledgmanl of Consent. <br /> l.&Y thalme wmtamin1rrrabonstaaanan1 Idenbaed In 40 CFR 26227(a)(if I am a large quanity generalort or(b}dl am a emall_a.-bilieneralmt ra sue. <br /> Ganeramrsfo"rs%ntedffyped Name Signi \` ldnnln Day Year <br /> 16.lntemaaonal Shrpments <br /> _ ❑Import to 6.8. ❑EapaRfmin U.S. nhyfexit <br /> Transporter signature Ifor exports only}: lea. U.S.: <br /> 6 17.7renspwterAckw Aedgmml or Receipt of MaWbk <br /> 7,—pone,1 PnntedyTyped Name�/ 6ugfsatura _ _ Mont) Day Year <br /> 2 tr 1. <br /> .11,—i pnmeWFy,-Name SiynatSver_ i Day Yaai <br /> 1 18.f)fscrepancy <br /> 18a.Dlscreparyy Lldlrabon Space [j 0uan ty E]Type T�Res tlue ❑Pa a Reje wn ❑Full Rajenien <br /> i8b.Alienate Fadery for Generator} Manifest Reference Number. <br /> J U.S.EPA ID Number I <br /> U <br /> t <br /> �Fadlily's Phone: <br /> T8c Signature of AJfm,dfe Fddfly(or Generator} <br /> � Month Day Year <br /> 2 <br /> 19.Hazardous Wasle Repoli Managemenl Method Codes(ia.,aides for hmirdous wade trOatnlont,disposal,and recycling systems) <br /> p � )I I 1 2, 7. <br /> 4. <br /> 20-011F3dldy 6A11af Or Operator:Cerlifimi of recelpl of hazardous miderials wvefed by the manIfOSt except as noted In Item lea <br /> PrrnfedlTyped Name Signature nut Day Year <br /> EPA 1`0[1118700-22(Rev.3-05)Previous editions are obsolete. i <br /> DESIGNATED FACILITY TO GENERATOR 'I <br /> JASON GAITAN, REHS Page 30 of 51 <br />