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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 1 800 424-9300 0182-37414 JJK ' <br /> 5.Generators Name and MaE[ing Addless Generators Site Address(tf different than maillng address) <br /> Q AND M, DBA TRACY CHEVROLET-QAN001 <br /> 3400 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Generators Phone: 209 835-4500 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 017 5 2 2 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 A Z R 0 0 0 5 2114 6 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(B any)) No. Type Quantity WL/Vol. <br /> 1'NON-RCRA HAZARDOUS WASTE,SOLID(PAPER FILTERS) 352 <br /> l DM 1�� <br /> P <br /> z 2. <br /> L <br /> t9 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#981:171 *PROFILE#9131: <br /> 162623NRSQAN001 PAPER FILTERS-APPROPRRIATE PPE EQUIPMENTc 7�// <br /> 15. GENERATOR'SICFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and acc umteE ve by the proper shippin me,and are classified,packaged, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport according to applicable Intema national governmental regulations. rt shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the tents of the attached EPAAcknowle4ppmT Consent <br /> cerffiy that the waste mInImIE09 statement Identified in 40 CFR 262.27(x)V I am a large quantity tor)or(b)(lf I am a small quantity gene s true. <br /> Generators! yped a Signature Month Day Year <br /> /9 <br /> _j 16.International Shipments <br /> it Import to U.S. S. ori of entryleudt <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TransporterAcknowledgment of Receipt of Materials <br /> Transp er 1 Printedrryped Nam Signature Month Day Year <br /> O ' D7a <br /> a2 Pd yped Nam �!, S Month ay Year <br /> L � /�.. <br /> IM <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ElType ElResidue ElPartial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> c� <br /> LL. FaciRYs Phone: <br /> W 18c.Signature of Alternate Faciitty(or Generator) Month Day Year <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4. <br /> 20.Designated Facfiity Owner or Operator.Cert fIcation of receipt of hazardous materials covered by the manifest a pt as noted in Item 18a <br /> Printed/Typed Namegn Month Day Year <br /> U <br /> EPA Form 8700.22(Rev.3-0 ) Previous editions are obsolete. D IGNA ED C TY TO DESTINATION STATE(IF REQUIRED) <br />