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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 1 800 424-9300 017696223 J J 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) TRACY CHEVROLET-Q&M INC 3400 AUTO PLAZA WAY TRACY CA 95304 Generator's Phone: 209 835-4500 6.Transporter 1 Company Name U.S.EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 8.Designated Facility Name and Site Address U.S.EPA ID Number YUMA YES LLC 2730 E 13TH ST YUMA AZ 85365 AZR000515924 Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Noi. 0 1' NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) g DMI P _.__.. Z 2. LU 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#9B1:162623NRSQAN001 OILY SOLID, PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT z-o 15. GEN ERATOR'SIOFFEROR'S 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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I,certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Gener ed Name Signature M t Day Year X 16.International j_ Import to U.S. Export from U.S. Port of entrylexit: z Transporter signs \(fexports o ty). Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Trans o0 1 Printed/TypeddL (ignatu Month Day Year a e t ` 1/ 7-1/3 me me Sig atur Month Day Ye ansp � e 18.Discrepancy 18a.Discrepag ndication Space Quantity iType ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: A 18c.Signature of Alternate Facility(or Generator) Month Day Year z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 12 T- LLJ 4. l r 20.Des g ated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printe ped Name, Sig(nat e Month Dayyy lYear - ' EPA Form 8700 22(Rev.3-05) Previous editions are obsolete. D 9SIG NATE DI FAChACY TO DESTINATION STATE(IF REQUIRED)