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Form Approved.OMB No.2050-0039 Please pent or e-(Form designed for use on elite 12-pitch)typewriter.} 1 ��ki}NUmt� 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number UNIFORM HA2AMOUS 01 s z 3 814 a �� WASTE MANIFEST A L O O G 3 3 D d 2 3 Generators Site Address{if different than mailing address) 5-Generators Name and Malting Address q V4 C. N[. D5'+TRAG Y C,HEVR0LET• QAN001 34W AUTO PLAZA WAY CA ❑K^L d TRACY Generator's Phone: - S,5 1 30 U.S.EPA 0 Number 6.Transporter 1 Comparry Name CAD 0 2 8 2 7 7 0 3 6 WORLD UiL ENVIRONMENTAL SERVICES U.S.EPA 4f]Number 7.Transporter 2 CotnpanY Name r=cvrRy Sys EM INC. ;R R C b D 1 7 i a Z U.S.EPA ID Number S.Designated Fa( fly Name and Site Address '(ES MANAGEMENT. ING. .3 SM LIS HIGH%V-AY 95 YUMA B53c-, D 5:2 1 '' G Fadi ga. 9b.U.S.COT Description(including Proper Shipping Name,Hazard Class,ID N3 jmhar, 10.Cor talners 19.Toth 12.Unit 13.Waste Codes and Packhtg Group(If any)] No. Type Quanfity Wt.Nok. HM i k 1.NON-I?cRA HAZARDOUS WAST;_ 352 a LU - 3. 4. 14,S lal Hardling InsstrKlions and Additional Information EMERGENCY CONT C I :CHEN3 I�E 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#9F'-- 173- ' . ;,�D1 . 162623QAN001 010 ABSORBENTS ' `APpR�7PFtIAi NFE F�:_II %M pO 101X 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignmerd are fully and accurataty described above by the proper shipping name,and are dasslfied,padcaged, marked and la5eledlplacardad,and are in all respects m proper condition for transport according to applicable intemationai and national govemmentai regulations.If export shipment and I am the Primary Exporter,I certify that ale contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I ceri4 that the waste minimization statement identified M 46 GFR 262.27(a)('d I am a large quantity generator)or(b)(if I am a small quantity generator)Is true. Month Day Year Generators DPfe[+1rs Priv IT d Name Signature �j 16.International Shipments Impart to U.S. ❑Export from U.S. Pori of I9xit: T^ saving U.S.: k Transporter signature{for exports only): w 17.TransporterAcknowtedgment of Receipt of MaWrials Month Day Year J Transporter I Printed Typed Name Signature r �� f ��,�� 0 20 Month Day Year Si Trans er 2 dnted3yped Name 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue Partial Repection Full Rejection Manifest Reference Number. U.S-EPA ID Number 18b,Alternate Facility(or Generator) J U W Facility's Phone; Month Day Year W 18c.Signature of Alternate-acAny(or Generator) 4 x N19.Hazardous Waste Report Management Method Codes(IA,codes far hazardous waste treatment,disposal,and recyGing systems 4 Q 1' Z 3. 2t7.Designated Factiiry Owner or Dparalor.Cer>tflcat on of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month NnUXYT ❑ay Year erne Signature EPA Form 8700-22(Rev.3.05 Previous editions are obsolete. DESIGNATED A 1LITYT ESTINATION STATE (IF REOUIRED)