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Please print or type. Fo2 Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Numb er 2.Page 1 of J.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 41 5 4 6 0 1 (800)424-9= 020383479 JJ K TEC OF CALIFORNIA-LOUISE AVE 5.Generatofs Name and MaRNng Address Generator's be Address(I(di8erent than mailing address) 2050 E LOUISE AVE LATHROP CA 95330 Generator's Phone: 209 65$-4110 6.Transporter 1 Company Name U.S.EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2$2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number ::::d WORLDWIDE RECOVERY SYSTEM INC. 1 B.Designated Facility Name and Site Address CAR00075422U.S.EPA ID Number YES MANAGEMENT, INC. 6500 US HIGHWAY 95 YUMA AZ 8535 Facility's Phone: (92813414-9828 A Z R 0 0 0 5 2 1 14 6 9a, 96.U.S.DOT Desaipdon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM antl Packirg Group(if any)) 13.Waste Codes No. Type DumblyWWaI. 1NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID) DIM zLE W f:1 tion EMERGENCY CONTACT:CHEMTREC I-NO.424.9300 WOES TERMINAL:CERES CS NAERGN 981 :171 *PROFILE M 981: 162623NRSTEC605 OILY SOLID * *APPROPRIATE PPE EQUIPMENT 1v�/� /x5 S' 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare he the contents of this consignment are Polly and accurately described above by the proper shipping name,ard 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 me Pamary Exporter,I certify that the contents of this consignment wnPorm 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 ' am a small quantity generator)is true. Gero tor's/OBerofs Pdnle�dR/y�ped Name Signature Month Day Year �./ . /"r 0 r� �j 16.International Shipments 0 O Al � ❑Import to U.S. ❑Export from U.S. Part of a /exk: = Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials f-2 Tra er 1 Printed/ryped^Name Sgnatu R Moboth Day Year �(O U) T�r�a11ns� rter 2 Pri ted/f ed Na 5ignatu e ! Mo Day Year Kt— Yom- NCl N 46j } 18.Discrepancy I Ise.Discrepancy Indication Space. _ . . ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Numbe 18b.Atemate Facility(or Generator) r: U.S.EPA ID Number J V LL Facility's Phone: W 18c.Sgnature ofAitemus Facnayfor(ienerator) Month Day Year Q z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1' 2. 3. 4. LForm signated Facility Owner a Operator Cedificafion of receipt of hazardous materials covered by me manifest except as noted in Item 18a /Typed Name , Sgnature m Day Vear u1 U - \) Cl ILI' f �EPA 8700-22(Rev. 2-17) Prevouseditbnsareobsolete. IGNATED FACILITY TO GENERATOR