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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 IQ Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking um or <br /> WASTE MANIFEST CAL 0 0 0 4 0 016 7 1 (800)424-9300 018526777 JJ K <br /> 5.Generator's Name and Mailing Address Generators Site Address(If different than mailing address) <br /> SPEEDEE OIL CHANGE&TUNE UP-GRANTLINE RD <br /> 245`W.LOUISE AVE <br /> MANTECA CA 95336 711 W. GRANTLINE RD <br /> Generator's Phone: 209 836-1557 TRACY CA 95376 <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 /> WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 A Z R 0 0 0 5 2 114 6 <br /> Facilitys Phone: (E28)344-9828 <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 Wtivol, <br /> CC 1-NON-RCRA HAZARDOUS WASTE SOLIDS(PAPER FILTERS) 352 <br /> 0 �� <br /> D M- 4 . P <br /> z 2. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information W 0 TY)17 D <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS PROFILE#961:162623NRSSPE099 <br /> PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT q*p- /q /I <br /> 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, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intematonal and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certtty that the contents of this consignment conform to the terms of the attached EPAAclmowtedgmenl 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 I am a small quantlty generator)is true. <br /> GeneratoesfOfferoes Printedrryped Name Signature Month Day Year <br /> 6 <br /> _r116.IntematibVal Shipments <br /> F ❑Import to U.S. ❑Export ham U.S. P rt of entryledl: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter AcknovAedgmenl of Receipt of Materials <br /> Trans er 1 Printedlryped Name// � Signature Month Day Year <br /> N <br /> za Transporter 2 Pdnte yped me Signature Month Day Year <br /> F� 0--'*1J' Z:E: L-e'PC OS <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue ❑Partial RejectionEl J <br /> Full Re ectton <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> .J <br /> c� <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of.recelpt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name 1nuSignature Month Day Year:G TUU � <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGN ED FAC O DESTINATION STATE(IF REQUIRED) <br />