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b Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 1 (800)424-9300 018526632 JJ K 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) Q AND M,DBA TRACY CHEVROLET-QAN001 3400 AUTO PLAZA WAY ' TRACY CA 95304 Generator's Phone: 209 835-4500. 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 01 7 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 Facility's Phone: (928)344-9828 AZR000521146 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hezard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity wt./Vol. NON-RCRA HAZARDOUS WASTE,SOLID(PAPER FILTERS) 2 52 O D M r�S ® P Z 2. w c7 3. x 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT. CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#9131:162623NRSQANOOI PAPER FILTERS * * P ROPRIATE PPE EQUIPMENT d x 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents.of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable international and national governmental regulations.If expert shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 1 certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am q small quantity generator)is true. MGuneratoes/Offeroe rintedlTyped Name Signature Month Day Year T lUv, _ e er- '/ . o d .J 1 16.International Shipments i— ❑Import to U.S. El Export from U.S. Port of entrylexit: z Transporter signature(far exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedfTyped Name Signature Month Day Year a �1/11`C�a-el j aZ Trans er 2 Printedrr ped Name Sig Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space O Quanti ty ❑Type ❑Residue ❑Partial RejecBen ❑Full RejeGion Manifest Reference Number. 18b.ARemate Facility(or Generator) U.S.EPA ID Number V uQ. Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month. Day Year Q Z 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 2. 3. 4. "l 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedJTypad Na Signa a Month Day Year 5-1 IS-1 1011 EPA Form 8700-22(Rev,3-05) Previous editions are obsolete. 0 D&SIG144*01MOLITY TO DESTINATION STATE(IF REQUIRED)