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Please print or type. Form desl ned for use or,elite 12-pitch typewriter. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Pegs 1 of 3.Emergency Response Phone 4.NIanHBat Tracking Number WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 1 (800)424-9300 018530287 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than malting address) Q AND M, DBA TRACY CHEVROLET-QAN001 3404 AUTO PLAZA WAY TRACY CA 95304 Generators Phone: 209 8355-4500. 6.Transporter 1 Company Name U.S.EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 017 5 4 2 2 8.Designated Facility Name and Site Address U.S.EPA ID Number YES MANAGEMENT, INC. 6500 US HIGHWAY 95 YUMA AZ 85365 A Z R 0 0 0 5 2 114 6 Facility's Phone: 9a. 9b•U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(Harry)) No. Type Quantity WWoI. 0 1'NON-RCRA HAZARDOUS WASTE,SOLID(PAPER FILTERS) 352 i DM JEO P Z W C) 3. 4. 14.Special Handling InsWctlons and Additional Information 5 1� EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#981:171 *PROFILE#9131: 162623NRSQANCOI PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT X's-s— 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are Polly and acort above by the p per shipping name,and are dasslfled,packaged, marked and labeled/placarded,and are In all respells in proper condition for transport according to applicable nal and national:�="w ulatiorts.H export shipment and I am the Primary Exporter,I certify that the contents of this consignment cordons to the terms of the attached EPA ment of Consent oentHythat the flan statement ldentiNed N 40 CFR 28227(a)Of I am a Imge generator)or(b)(If I am a small gootrue. Signature Month Day Year l d� F 16.International Shipments Elimport M U.S. port from U Port of enWextk z Transporter signature(for exports only): Da leaving U.S.: W 17.TransporlarAcknovrledgment of Receipt of Materials a T 1 &bdflyped Signature Month Day Year O b a Z< T rter2Prtntsdliyped Signatu Month Day Year r d 18.Discrepancy Of 18s.Discrepancy Indk at on Space ❑ Quantity ❑Type ❑Residue ❑Partial Re)ecU, ❑Full Re)eotton Manifest Reference Number. 18b.Altemata Facility(or Generator) U.S.EPA ID Number c� ri Fadity/s Phone: w 18c.Signature ofAltemate Facility(or Generator) Month Day Year y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G _T 3. 4. 20.Designated Facility Owner or Operator.Certification of recelpt of hazardous materials covered by the manifest except as noted in Item 1 Pdn ante _ nature ear u r 101 EPA Form 8700.22(R03-05)3-05) Previous editions are obsolete. DESIGNATED FACT TO NATION STATE(IF REQUIRED)