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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4 Manliest Tracking Number <br /> WASTE MANIFEST I CAL 0 0 0 4 0 0 1 6 7 1 (800)424-9300 020 3 8 3 411 JJ K <br /> 5.Generator's Name and MaMnq Address Generator's Site Address(d different than malting address) <br /> SPEEDEE OIL CHANGE&TUNE UP-GRANTLINE RD <br /> 245 W. LOUISE AVE <br /> MANTECA CA 95336 711 W. GRANTLINE RD <br /> Generators 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 0 1 7 5 4 2 2 <br /> 8.Designated FadUty Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 AZR000521146 <br /> Fadlitys Phone: (928)344-9828 <br /> 9a 9b•U.S.DOT Description pndudirg Proper Shipping Name,Hazard Class,ID Number, 10.Contakhers11.Total 12 Un t 13.Waste Codes <br /> HM -d Packing Group(if any)) No. Type Quantity WtNol. <br /> 0 1.NON-RCRA HAZARDOUS WASTE SOLIDS(PAPER FILTERS) 352 <br /> DM P <br /> z 2. <br /> w <br /> t9 <br /> 3. <br /> 4. <br /> tA <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800.424-9300 WOES TERMINAL:CERES CS *PROFILE#961:162623NRSSPE099 <br /> PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT X 5S <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and aaurately described above by the proper shipping name,and are dassifW,packaged, <br /> marked and labeledlplacarded,and are In all respects In proper conditkm for transport according to applicable inteaatonaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the teas of the attached EPAAd=Wedgment of Consent <br /> certify that the waste minhnization statement Identified in 40 CFR 26227(a)(H I am a large quantity generator)or(b)(Iii am a small quantity generator)Is true. <br /> GB tarslOfferors PrintedlTyped Name 71�fiU411-41— <br /> Month DayYearYear <br /> f 10 <br /> 16.International Shipments <br /> Import to U.S. ❑Export from U.S. Port of entrylextt• <br /> Transporter signature(for exports only): Date Wng U.S.: <br /> IX 17.TransporterAdvrowledgment of Receipt of Matedals <br /> Tra r 1 PentecliTyped Ntme Signature Month Day Year <br /> O <br /> a <br /> Trans 2 •tedliped lame Signature Month Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quanti ❑Residue <br /> ty ❑Type ❑Partial Rejection ❑Full ReJecton <br /> Manifest Reference Number. <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> v <br /> ra+- FaaTitys Plane: <br /> W 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. f-�L-A 2. 3. 4. <br /> 20.Designated Fadltty Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in IIR 18a <br /> Pr v yped Name _ Signature Man Day Year <br /> 23 1 g <br /> EPA Form 8700-22(Rev. 2-17) Previous editions are c U ESIG D CILITY TO EPA's"e-MANIFEST SYSTEM <br />