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Please oft or type. <br />Received by EHD on 11/13/19 <br />-C. Lawrence <br />Form Aooroved. OME No. 2050.0039 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. J <br />DESf fIE=D FACILITY TO EPA's e-MAN[FEST SYSTEM <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. Mastiiast Tsactdng dumber <br />WASTE MANIFEST <br />CAL 0 0 0 3 7 1 2 1 0 <br />1 <br />(800) 424-9300 <br />0203831 598 JJ K <br />5. Generatafs (Name and WEng Address Generator's Site Address (d dlf'erent than malfing address) <br />MORGAN AUTOMOTIVE REPAIR MANTECA <br />2073 E YOSEMITE AVE. <br />MANTECA CA 95336 <br />Generators Phone: 209 825-9335 <br />E. Transporter t Company Name U.S. EPA ID Nrunber <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. Des gnated Facioty Name and Site Address U.S. EPA ID Nrunber <br />YES MANAGEMENT. INC. <br />6500 US HIGHWAY 95 <br />YUMA AZ 85365 A Z R 0 0 0 5 2 1 Z 4 5 <br />Fack ysPhone: (928)344-9828 <br />ga <br />9b. U.S. DOT Description Cmdudirg Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />73, Waste Codes <br />No. <br />Type <br />HM <br />and Pack* Group (d any)) <br />Quantity <br />WtN¢I. <br />1 NON-RCRA HAZARDOUS WASTE, SOLID (PAPER, FILTERS) <br />F- <br />1,rJ o <br />352 <br />DIM <br />P <br />LU <br />2. <br />ul <br />i7 <br />3. <br />4. <br />14. Specht HarodwV instructions and Additional Information <br />EMERGENCY CONTACT : CHEMTREC 1-800424-9300 WOES TERMINAL: CERES CS * PROFILE # 9B1 : 362623NRSMOR063 <br />PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT 1.�_ ® 1;, I Y <br />SL <br />15. GENERATOR'S14FFEROR'S CERTIFICATION: I hereby deflate that the contents of this consignment are fully and aaurately described abof ve bby�the proper shlppmg name, and a lass fed, packaged, <br />marked and Iabeledlplacarded, and are in all respects In proper oondltion for transport acoading to appl!tabla InternaElonal and national govemmerlal regulations. If export shipment anti I am the Primary <br />EVorter, I cert4 that the oontents of this consignment conform to the temis of the attached EPAAckmivledgment of Consent, <br />oertily that the waste rrhmizaCon statement identified in 40 CFR 262.27(a) (f I am a large quantity generator) or (b) (dJ am a smag quantity generator) Is ll <br />Generatces/Gff roe's Pdnt.aff Ted Name Signature Month Day Year <br />�'l 9 <br />❑ Import to U.S. ❑ U.S. CAof entrylexit: <br />FS <br />Transporter signature (for exports only): a a leaving U.S',: <br />f e 17. <br />Transporter AdmoWedgment of Receipt of Materials <br />Trans porter IPdntedfTypadName <br />' <br />Signature Monlh Day Year <br />a <br />taw <br />-�� a S 1 <br />T erapedl SEg Month Day Year <br />r1/1 <br />18. Discrepancy <br />18a. Discrepancy Con Space ❑ Quantity pe Residue ❑ ParW R%ll ❑ Fufl Rejection <br />Margfesl Reference Number. <br />18b. Alternate Feel (or Generator) U.S. FPA ID Number <br />z <br />[J <br />rQ <br />Faditys Perone: <br />LU <br />180.Signas m&ARemateFacility (or Generator) Month Day Year <br />Q <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyd!rg systems) <br />0 <br />1 � <br />2. <br />Z. <br />4. <br />20. Designated FacaT.tly Owner or Operator. Cerffc3Can of receipt of hazardous materials covered by the manifest except as tr,Aed In Ilem 183 <br />PrinledlTypedilame Sigratare Mo th Day <br />(Year <br />P( L LI <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. J <br />DESf fIE=D FACILITY TO EPA's e-MAN[FEST SYSTEM <br />