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Form Approved.QM6 No,2050-0039 <br /> Please print a type.(Form designed for use on elite(12-plch)typ wriler.) 4.1pan(i[}aa+t�Trackkn Number �]f'� _I �[ <br /> UNIFORM 14AWDOU5 1.Gena+alar l0 Number 2.Page t of 3.Fs1)ergerwy fta5ponsa Pnono l!1� �� �� I V �+�I� <br /> WASTE MANIFEST c A t a a a 3 s b fl .� i O •^*3300 <br /> 5.Generator's Nanta and Mailing Address Qdremkor't$i16 Address(if diiferenk than <br /> maiUng sddross) <br /> IM ERIAL TRUCK WASH AND REPAIR JAll GROUP <br /> Z142 W.YOSEMITE AVE JA??GROUP It C <br /> IYiANTECA CA 95337 <br /> r enerntoda phone: 209239-813-1 U.S.EPA ID Number <br /> B-Trmteporfer 1 Company Name <br /> +14ORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> U.S.EPA ID Numl7er <br /> 7.Transporter 2 Company Neme <br /> WORLDWIDE RECOVERY SYSTEM INC C A R 0 0 )1 7 2 2 <br /> U,S.EPA(0 Number <br /> a-Designated Facility Neme and Site Address <br /> YES MANAGEMENT. INC <br /> 6506 US HIGHWAY 95 <br /> YUNIA A? s:5:ti3 A? R 0 0 0 5? 114 0 <br /> FaoitktylsPhone: n"I "a ,_ . ^so <br /> 9p,U S.DOT Desalption(indur 4 Prager 9hipyling Noma,Hazard Class.ID N bet, 10.Containers Quantity nirky11.TOW 12.Unit 13,Waste Gales <br /> HM and PaO4 Group Of aRy)) No. TypeQuNNVd• <br /> 1,NON-RCRA HA—ZARDOUS WASTE, SOL,l7(PAPER FiLT Ra) 7 <br /> M -700 <br /> 2. <br /> W - <br /> 4. _ <br /> 14.&Nail Hardkfng Inshudk tis arxi Addituana€Infamsedon <br /> EMERGENCY CONTACT :CHENITREC �-500-424-9300 I VOES TERMINAL; CERES 05 NAERG#9BI:14 PROFILE#9al; <br /> 162623NRSIMP072 PAPER FILTERS M w APPROPRIATE PPE~EQUIPMENT 41-IM f <br /> 15. GENERA70R'31OFFER0It'8 CERTIFICATION: I!Hereby doctors that 11ne cgnierrts 3t Wa GoraN meet are fully and acwmbk} descnbod Wf ova by Ute pry nb9f4ng nerrie,and are deasfiad,padraged, <br /> marked and labafedlplacardad,and are in atl respects!n props oondllkon for ttmmrvwqx aaoording to sppE"Wa int&mft+W and nead govemmental regulatioq%ff export shipment and I am the Primary <br /> tnt <br /> Exporter,I certify that she contents of INs conelgrunant conform to the tORTM of thea � r b)trG f!sm a 6mo11 quantity ganemw 3s true• <br /> I card y*het u waits mininuaWn stamrrpnl Idem fled in 40 CFR 262,27(x)Co I an month Day Year <br /> Generate✓ srots pdulteoyped Name / Signature <br /> LIZZ I/ <br /> /,-,- I x <br /> tines lV , <br /> 16.1aterkqonal SNixneil$ ❑ U.S, P <br /> from ert df enttyfaxrb <br /> 11€mport to u.s, Evod <br /> Transporter*nature{fpr exports only}: Date!oaring U.S,: <br /> 17.Transporlar Admmiedgment of Receipt of Matpos <br /> Trans Pentecyped <br /> 1 Name Signalum Month Eley -Year <br /> *ter 2 Priv ma Signature Month Day Yfnar <br /> 9 <br /> Ia.Discrapapq <br /> lea.Disraeparwylndcaltort5pace El Ouarllity ❑TY R.M. <br /> ❑Padel Rejection ❑Fut!Relectlon <br /> I,tan€test Reference Number. <br /> 1 Bb.Attarnate Facility(or Gane+stnr) U.S,EPA;D Number <br /> U <br /> u� Facttily's Phone: <br /> 18G. nature of Fe IV{or Generator) Month Day Year <br /> Sig <br /> d <br /> LU <br /> 1$.Haumous Waste Repot Management McBwd Codes p.a.,Godes fir hazardous was B beatmartL disposal,and iecydirig systems) <br /> 3. 4- <br /> 20.Designated Fadity Owner or Operator.Certfkat&of:"pt of hazardous materials xmKW by the mwSsf anapt as rued In Item 194 <br /> ntocuHa <br /> F ma Slpnature Mant11 Day Year <br /> cA Stu , t l 1 0 t 9 <br /> EPA Form 8700-22(Rev. 5) Previous editions ars obsolete. DESIGNAT F� DESTINATION STATE(IF REQUIRED) <br />