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Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORKHAZARDOUS' 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST I C AL 0 0 0 4 0 01 6 7 1 800 424-9300 016870474 JJK 5.Generator's Name and Mailing Address Generator's SlteAddress(if different than mailing address) SPEEDEE OIL CHANGE&TUNE UP-GRANTLINE RD 245 W. LOUISE AVE MANTECA CA 95336 711 W. GRANTLINE RD Generator's Phone: 209 836-1557 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. 8.Designated Facility Name and Site Address U.S.EPA ID Number YES MANAGEMENT, INC. 6500 US HIGHWAY 95 YUMA AZ 85365 AZR000521146 Facility's Phone: 1998)344-9898 ga, 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(f any)) No. Type Quantity WWoI. o VON-RCRA HAZARDOUS WASTE SOLIDS(PAPER FILTERS,OILY J SOLIDS) DM ` P z z. L 0 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#981:162623NRSSPE099 OILYSOLIDS, PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT # a 0 coq 1 X S S k Ip y 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described aboveby the proper shippInd name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable International and,nagonal 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 EPA Acknowledgment 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. GeneratoeslOfferoes PrintedlTyped Name Signature Month Day Year r j 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signatur Month Day Year 0 1 GI�a� 1 ZZ Transporter 2 Pdntedfryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number . U LL Facility's Phone: In 18c.Signature ofAllemate Facility(or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. (✓ 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name - Signature Mo Day Year 4 it I /)/,14 1 A I� � aCe ,Iq EPA Form 8700.22(Rev.3.05) Previous editions are obsolete. DESIGNATED FA-6frr4 TO DESTINATION STATE(IF REQUIRED)