Laserfiche WebLink
Please print or type. <br />Form Approved. OMB No. 2050-0039 <br />EPA Form B700-22 (Rev. 12-17) 3�vious editions are obsolete. <br />DEGIQNATED FAJITY TO EPA's e -MANIFEST SYSTE;. <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />CAL 0 0 4 5 5 4 <br />2, Page 1 of <br />1 <br />3. Emergency Response Phone <br />424-9300 <br />4. ManlfestTrackingNNumber <br />8 <br />021523871 <br />JJ K <br />WASTE MANIFEST <br />0 01 <br />(800) <br />5. Generators Name and Mailing Address Generaloes Site Address (ii different than mailing address) <br />TRACY CHRYSLER DODGE JEEP RAM <br />3460 NAG LEE RD <br />TRACY CA 95304 <br />Generators Phone: 209 820-1800 <br />6- Transporter 1 Company Name U.S. EPA Ip Ntxrhher <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 01 7 5 4 2 2 <br />8. Designated Fadlity Name and Site Address U.S. SPA ID Number <br />YES MANAGEMENT, INC. <br />6500 U5 HIGHWAY 95 <br />YUMA AZ 85365 AZ R000521146 <br />Facilil Is Phone: (928).344-9828 <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Tolal <br />12, Unit <br />Waste Cedes <br />No. <br />Type <br />HM <br />and Packing Group V any)) <br />quantity <br />VA./vol.13. <br />0 <br />1' NON•RCRA HAZARDOUS WASTE, SOLID (OILY SOLIDS) <br />362 <br />DM <br />56D <br />P <br />ua <br />M <br />2. <br />LU <br />3- <br />4. <br />14- Special Handling Instructions and Additional Information <br />EMERGENCY CONTACT : CHEMTREC 1-800-424-9300 WOES TERMINAL: CERES CS NAERG# 9B1 : 171 * PROFILE # 9B1 : <br />TRA691-162623NRS OILY SOLIDS* *APPROPRIATE PPE EQUIPMENT '2— �e 5_g <br />15. GEN ERATOR'SIOFFEROWS 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 Iabetadlplacarded, and are in all respects in proper condi0on for transport according to applicable intematianaland national gowemmental regulations. If export shipment and t am the Primary <br />Exportw, I certify that the contents of this oonsgnment conform to the term of the attached EPA Acknowledgment 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 [h] (if I am a small quantity generator) is hie. <br />GenefatoesJ roes PnnladlTyped Name Signature Month <br />Day Year <br />c( Z 4 <br />E� <br />16. lntematonal Shipments Import to U.S. ❑ Export from U.S. Port of enWaxit_ <br />? <br />Transporter signahrre for exports only); Date leaving U.S.: <br />W <br />17. TransporterAdomviedgrnent of Receipt of Materials <br />w— <br />O' <br />Transporter 1 Phntedffyped Name Signature Montt <br />Day Year <br />.r vL4�1' �` hH'1/� �� Z t V <br />M 2, � <br />X <br />Transporter 2 Pdnte&T 'Name Signature ! Monty <br />Day Year <br />/ f— <br />L I z L, <br />18. Discrepancy ` <br />18a. D4surupancy Indicatiun Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial R*don ❑ FuH Repeetion <br />Manifest Reference Number. <br />18b. Alternate Faci3ity (or Generator) U.S. EPA ID Number <br />J <br />U <br />rai <br />radlWs Phone: <br />w <br />18c. Signature of Alternate Facility for Generator) <br />Month <br />Day Yea, <br />Q <br />Z <br />0 N <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment. disposal, and racyc]ing systems) <br />� <br />1. <br />\�A\ <br />2. <br />3. <br />4 <br />20. Desgnated Facility Owner or Operator. CertflcaWrk of receipt of hazardous malehats covered by the manifest except as rioted In Item 1 Sa <br />- <br />I, <br />Print e Signature Month <br />(2a<�,Vury-\ 1 �4 7AA El -Le� <br />Day Year <br />M [2 10 <br />EPA Form B700-22 (Rev. 12-17) 3�vious editions are obsolete. <br />DEGIQNATED FAJITY TO EPA's e -MANIFEST SYSTE;. <br />