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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 4 0 0 1 6 7 1 800 424-9300 018 2 3 7 2 4 4 JJ K 5.Generators Name and Mailing Address Generator's Site Address If different than mailing address) SPEEDEE OIL CHANGE&TUNE UP-GRANTLINE RD 245 V11. LOUISE AVE MANTf CA CA 95336 711 W. GRANTLINE RD Generalces 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. CAR 0 0 01 7 5 4 2 2 8.Designated Facility Name and Site Address U.S.EPA ID Number YES iViANAGEMENT. INC. 6500 US HIGHWAY 95 YLiiviA AZ 85365 A Z R 0 0 0 5 2. 1. 14 6 Facililys Phone: q ga gb.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 Wtivol. 1.NUN-RCRA HAZARDOUS WASTE SOLIDS(PAPER FILTERS) l352 1 DM �'?%b P I i L I i I i 3. 1 I a. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT: CHEMTREC 1-800-424-9300 WOES TERMINAL: CERES CS x PROFILE#961 :162623NRSSPE099 PAPF'R FILTERS x "APPROPRIATE PPE EQUIPMEN Tit )�(3 `)- 15. GENERATOR'S10FFEROR'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. Generaloesl0fferoes Printedrryped Name Signature Month Day Year ,c 4,0 /I —.r 16.friternational Shipments F— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter t PrintedfTypeda Signator , / Month Day Year a v{� 4t �"1 r✓ ("� 7 X71 I Z Transports( rirtedJTyped Name Sign re Month Day Yel�r 18.Discrepancy 18a.Discrgp cy Indication Space ❑ QuantityType ❑Residue ❑Partial Rejecfion ❑Full Rejection Manffest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V Facility's Phone: LOU 18c.Signature of Alternate Facility(or Generator) Month Day Year a 2) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Uj 1. rr A� 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 M th Day clu w T EPA Farm 8700-22(Rev.3-05) Previous editions are obsolete. f�k51GIVAT D F�ACII 1TY DEa f'INATION ;T�itk (IIS Fir-ouipr-in)