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Please print or . Form designed for use on. elite (12•pitch) typewriter.) WIN <br /> Form Appravod, OMB Na, 20500039 <br /> UNIFORM HAZARDOUS1 end to 0 ONwnber 2. Page 10( 3. Emergency Response Pham Manifest Tracking Numbat <br /> WASTE MANIFEST 0257627 1 (80()) 424. 9300 0 67913 JJ K <br /> 5. Gene bas Name and k g Address Genarators She Address (if different then mailing address) <br /> CABRAAL CHRYSLER WESTERN MOTORS - CAD011 - <br /> P .0. BOX 2186 <br /> MANTECA CA 95336 1145 W YOSEMITE AVE <br /> GenstatorsPhoaet 209 823-:1148 MANTiCA CA 95337 <br /> 6. Transportori CompanyName U.S. EPA 10 Number <br /> WORLD OIL ENVIRONMENTAL SERVICES C AD 0 2 8 2 7 7 0 3 6 <br /> 7: Tran <br /> sporlar 2 Company Name U.S. EPA D Number <br /> WORLDWIDE RECOVERY SYSTEM INC, CAR 0 U 0* 1. 7 5 4 2 2 <br /> s A. Designated Factity Hama and Site Address U.S. EPA IQ Number <br /> YUMA YES LLG <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 A Z R O 0. 0 515 0 2 4 <br /> Fscifrt a Pion: <br /> ga eb. U.S. DOTDescription (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Tow 12. Unit 13, Waste Codes. <br /> i <br /> HM and Packing Croup (d any)) No. Type Quantity 4 • <br /> IV <br /> NON-RCRA HA7ARDOUS WASTE , SOLID ( OILY SOLID, PAPER FILTERS) ( , 352 qR, <br /> D <br /> 21 <br /> } <br /> 8 3 <br /> r <br /> k <br /> 4. Wal Handing Instructions and, ditonat InformationL <br /> EMEKOENCY CONTACT : CHEMTREC 1-800.424.9300 WOES TERMINAL: CERE:S CS * PROFILE #f 981-, ' 62623NRSCABOII <br /> OILY SOLID, PAPER FILTERS * * APPROPRIATE PERSONAL Pf7OTE2E; II' ENT .f( ,'j pe OWN :J <br /> tui. GENERATOWS/oFFEROR'S CERTiFfCAT[ON: I hereby declare that the contents of Ws consignment are fully and a=tateiy described above by the proper Shipping name, andare cessified, packaged, <br /> marked and Iabeled"carded, and aro N ail respects in propertond2btt for transport acceding to applicable International and national governmental mQutauons. It export ahipmeni and I am the Primary <br /> Exporter, I cerdfy that the contents of this consignment conform to the terms of the attached EPAAgknowledgment of Consent. <br /> 3 I Uraline waste minimization statemenfidendfied In 40.CFR 262,27(6) Of ram a large g4antrly gerorator) or (b) (&I am a small quantify qGnw%'IsdtruKV <br /> i awsl Pdntedliy s Sgnetdre Monthay ear <br /> lama Shpmenis <br /> e ❑ impart to U.S. ❑ Export from U.S. Port of ani <br /> Tran"t signature (for exports only): Data leaving <br /> 17. TranspodazAcknoMedgmenlofRac�lptofMatxiais <br /> ry, Tra i M yped ams Slgneture Month ay //ear <br /> © 06 fa <br /> T n pod 2 Pr' dfripidNaime Month Day ear <br /> 18. D'atreparhoy �, <br /> Mgt 01seepancy thdication Space QuAnhiy ❑ Type ❑ Resists ❑ Panel Rojaciion ❑ Full Ra)Worh <br /> Manifest Referenoo Numw,% <br /> 18b. Abarnate Facility (e Generator) U.S. EPA ID Number <br /> FatB"' Prone: <br /> g fie. Signature o lemate ac or nerata) V en Day Year <br /> ZG, <br /> 1g, Hazardous Wasla Report Management Method Codes (Le., codes for Ae2arddus oasis treaunerht,.disposa), and recycling systems) ? <br /> LU <br /> i 24 3, ¢• ' <br /> a <br /> A L <br /> 20, Dodgpafad Fac2py O�"r or Opatator. Carkfcafeti of reeeipt of haxatdous materials cadafed by Illie 1118085t We ed in Item 1 Be <br /> PrintsM2m <br /> t Bignaturs th ay ear <br /> EPA Form B700. ev. 5.05) Previous editions are obsolete. DL SIG NVED FACILITY •Pq D _- rINATION STATE (IF REQUIRED) <br />