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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 0 016 7 '1 (800)424-9300 017467994 JJ K 5.Generator's Name and Mailing Address Generators Site Address(if different Nen mailing address) SPEEDEE OIL CHANGE&TUNE UP-GRANTLINE RD 245 W. LOUISE AVE MANTECA CA 95336 111 W. GRANTLINE RD Generators Phone: 209836-1557 TRACYCA 95376 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 YUMA YES LLC 2730 E 13TH ST YUMA AZ 85365 Facility's Phone: A 7_ R 0 0 0 515 9 2 4 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codas HM and Packing Group(if any)) No. Type Quantity Wtivol. of tNON-RCRA HAZARDOUS WASTE SOLIDS(PAPER FILTERS, OILY of SOLIDS) 9 DM L�n O P )52 Z Z. W 0 3. 4. 14.Special Handling Instructions and Additional Information Q 5--4 P r n EMERGENCY CONTACT:CHEMTREC 1.800-424.9300 WOES TERMINAL: CERES CS *PROFILE#961 : 162623NRSSPE099 OILYSOLIDS. PAPER FILTERS * *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENTn 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, marked and lobeledlplacarded,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 EPA Acknowledgment of Consent. I cerfly that the waste minimization statement Idenlified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is two. G ner rs/Off rs Printed/ryped Name Si rat re 1 / � / Month Day Year J 16.Intematian I Shipments 2 \LJ import to U.S. ❑Export from U.S. Pon of enby/exit; Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAcknowledgment Receipt of Mata' Is Transpod 'nledRyp Na Signature Month DayYearYear CL l9 Zd ZTre sp Qre Pnnedfrypetl Nala Signal Month Day Year jY 18.Discrepancy �/ 18a.Discrepancy Indication Space ❑SQuznti Type b ❑ YP ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: zi 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U I Facility's Phone: w 18c.Signature of ManFacility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. V4 2. 3. 4. 20.DtfaiKated Facility Owneror Operator.Cemfication of receipt of hazardous materials covered by the manifest except dad in Item Ise Print tlRyp a Signature Month Day Year EPA Form 00-22(Rev.3-05) Previous editions are obsolete. DESIG 1TED FACILITY TO DESTINATION STATE(IF R�QUIRED)