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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 23: The following uniform hazardous waste manifest(020380612JJK) observed lacking signed copy. <br /> _ Prease print ,type. - - - <br /> UNIFORMHAZAR000S 1 Generate-C Number Fann Approved.CMB Na_205MG39 <br /> WASTE MANfFE3T 2 Page 1 of d.Emergency RBspansePMne T Manilaat Tracking Hurr2 ar <br /> CAL0003aO423 1 I'WO)424-4300 020 8061,2 JJK <br /> 5 Gerceratprskame and Mailing Addmaa GeneratMe6Ae Address{irddfemnt Nan maulrq�amasl <br /> QDBA TRACY CHEVROLET-Wool <br /> 3400 AUTO PLAZA WAY <br /> r--w,ph.. 208 836.4500 CA 45304 <br /> ...v_� 6.T—poder 1 Company Nama <br /> -=GsOR WORLD OIL ENVIRONMENTAL SERVICES us.EFAtDNember <br /> Dlxt ITreri> tar2Company61 sADNm02S <br /> 277030 <br /> WORLDWIDRECOVERY SYSEM INC EPAIDdar <br /> D <br /> E.Designated Ferility Name and S, Address CAR 0 0 0 1 7 5 4 2 2 <br /> 1 <br /> For YES MANAGEMENT,INC. U.s.EPACKaieer <br /> F -- <br /> 56f $800 US HIGHWAY 85 - �+ <br /> Min <br /> YUMA AZ 863Bb <br /> 5 Fe ry'aPhone: AZR000521146 <br /> S 9a. 9b US DOT Deaoipaen(mGuding ProperShipplrp Name,Hazard Cl—,IU Numyar. 1o.Canramers T <br /> H HM uN Packag Group ld ahy' 11 Total 52,Unit —r•.+ <br /> No. Type t7uandly WWVq_ 1a.Wase Cases <br /> �� HP s 'NON-RCM HAZARDOUg WASTE.SOLID{OILY 301Jp) <br /> P <br /> P. p �, ysa2 `.�'' <br /> T 0M P r_ <br /> D o x s <br /> 1 3 <br /> I � <br /> 14.Speual Handling rush 1tena 31x1Addiaenat Inlem,eden <br /> EMERGENCY CONTACT:CHEMTREC 1-80x424.9300 WOES TERMINAL:CERES CS NAERGS 801:171*PROFILE M 4B1 <br /> 102623QANOGI OILY ABSORBENTS* *APPROPRIATE PPE EQUIPMENT A d G) <br /> X�� ^ <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATWN:Thereby declan:mai Ne conlentsMNis mnsgnmenl aro fatly and ecaualely descdtlatl above by themarked and IaCeladlplararde4 and are in all respects in properNMidpn hr Vanapal a[tpding b apyicable inlemabaWand nadolol PmperShAaPn9 rearua.sN Tu A LAS thap mart' _ <br /> governmental regulaliats-IF expel sNpnbN aM I inn Ne Pr'rnan <br /> Exporter.I cetiy that the—hints of this consignment r—Wm to the M_of the attached EPAAck,.-4adgmer(0 _ <br /> IrxvefyNal the waste minimization sralament ltlend(ied moa CFR 262.27(eJ fg lamelargequandty genemto� [dlamasmallquAgeneratNy is In. <br /> Ge�ratol PPad Nartm S to MaM Day Year <br /> y <br /> —1 16 hLerri <br /> Import 4p U.S. ❑EMportfiom USS! Porlofenbrylw- _ <br /> TranspoNar ygnaWre llor expMs onyJ: Daae leaning U.S.. <br /> � w 17.TranspoderAcl{nowledgmenl of Receipt of Maledals <br /> Transporter l P4nted/Tpped Name Signature -- <br /> a- Lit O 'n- Monty Day Year :;AFS I�I1 rL Ui1 <br /> —�— --—---- „ z Transporter 2 P4ra-,yped Name Slyatare <br /> Monty Day Yea — <br /> ___ � I6.Discrepancy — <br /> 1 Ba.Discrepancy md¢abon Space ❑Ouanhty <br /> ❑TYpe ❑Residua ❑Partial Rs{octton El Rill Rejection <br /> Manilest Rafereme Number <br /> 186 Nlernale Facility(a Generator) U.S.EPA 10 Number <br /> U <br /> sQi Faadlys Phone: <br /> w 13C,Srgnalureof Allemale Facdiy for Genoratar) Mantn Oar ywr <br /> Q <br /> 2 <br /> — CD 19 hazerdous Waste Repo4 Management Method Codes Ike,tales la hazardous waste Ifea4lwnl,disposal,and recycling systems) <br /> t'0 Designated Fadllty Owner or Operator:Certiflcallan o}tecetpt of hazardous materials covered by the r ilesl oxmpt as wed in Item 183 <br /> i� 1 Pnnledr�yped Name Signature h1onN ID <br /> EPA Form 87CO-22(Rey.12-17)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 23 of 48 <br />