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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2200 - Hazardous Waste Program
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PR0514278
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
8/18/2021 3:38:06 PM
Creation date
2/16/2021 2:22:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0514278
PE
2228
FACILITY_ID
FA0010308
FACILITY_NAME
TRACY CHEVROLET
STREET_NUMBER
3400
STREET_NAME
AUTO PLAZA
STREET_TYPE
WAY
City
TRACY
Zip
95376
APN
21227011
CURRENT_STATUS
01
SITE_LOCATION
3400 AUTO PLAZA WAY
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\gmartinez
Tags
EHD - Public
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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 1 (800)424-9300 013 5 313 3 3 JJ K <br /> 5.Generator's Name and Mallin Address Generator's Site Address(if different than mailing address) <br /> Q AND M, DBA TRi�CY CHEVROLET-QAN001 <br /> 3400 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Generator's Phone: 209 835-4500 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <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 /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> WORLD OIL RECYCLING <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 CAT080013352 <br /> Facility's Phone: (310)537-7100 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol. <br /> ON1993,WASTE FLAMMABLE LIQUID, N.O.S.,(GASOLINE, DIESEL),3, 001 018 43 <br /> PG 11 <br /> DM !�4 G <br /> z 2. <br /> LU <br /> C9 �- <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#9131:128 *PROFILE#9B1: <br /> 426350 GASOLINE, DIESEL* *APPROPRIATE PPE EQUIPMENT - <br /> 15. GENERATOR'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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if 1 am a s2BIl quantity generator)is true. <br /> Generatoesl�f,[ors Pi dlTyped Name Signature Month Day Year <br /> x oY lf-r i x JL/Z �T <br /> 16.International Shipments <br /> t- ❑Import to U.S. El Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> LU 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter1 Printedfryped Name Signa Month Day Year <br /> aTransporter 2 Printedlfyped Name Signalure Month Day Year <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue Partial RejectionRejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 <br /> G <br /> Nw <br /> 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed(r ame Signature Month Day Year <br /> li-a 0 6-Q leZ <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FAC ITV TO DESTINATION STATE(IF REQUIRED) <br />
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