COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Generator Ib Number 2.Page i 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 017 6968 7 4 JJ K 5.Generators Name and Mailing Address Generalor's Site Address(if different than mailing address) TRACY CHEVROLET-Q& M INC 3400 AUTO PLAZA WAY TRACY CA 95304 Generators 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 WORLDVIIIDE PECOVERY SYSTEM INC. C A RO 0 01 7 5 4 2 2 8.Designated Facility Name and Site Address U.S.EPA ID Number YUNIA YES LLG 2-130 E J-3 HH ST Y.UMA AZ 85365 AZR0005.15924 Facility's Phone: (928)344.9828 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 16.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Arol. 13.Waste Codes "NON-li HAZARDOUS tt'uASTE,SOLID(OILY SOLID. PAPER FILTERS) O 352 ILi 2-oo P z 2. U1 ILD 3. 4. 14.Special Handling Instructions and Addltionai Information WIG Q 7 EMERGENCY CONTACT : ClgEMTREC 1-800-424-9300 WOES TERMINAL: CEDES CS *PROFtLE##961 :162623NRSQANOOI OILY SOLID. PAPER FMERS 'r 't APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 4f Za29 l X5- 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 Iabeledlplacarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulations.4f export shipment and I am the Primary Exporter,l certify that the contents of this consignment conform to the tarts of the attached EPA Acknowledgment of Consent. I certily that the waste minimization statement identified in 4 CFR 262.27(a)(if I am a large quantity generator)or(b)(if i am,a&vnrquaPty generator)is true. Gen IorsfOfferor, Sign ure Month Day Year situ 0 j 16.Int—ornational Shipments F— ❑Import to U.S. Export from U.S. ort of entrylexit: Transporter signature(for exports only): Date leaving U.S.: Ce 17.TransporlerAcknowiedgment of Receipt of Materials Transpo r rintedlTyped me Signature Month Day Year CJ Transporter 2 Printedlfyped Nam Signa tur Month Day Year I S.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V U. Facility's Phone. w 18a Signature of Altemate Facility(or Generator) Month Day Year d CD 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4, 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest ex pt Tided in Item 18a Printed fpe Name ` Si atur M Day Year L EPA Form 8 D-22(Rev.3-05) Previous editions are obsolete. Dt�SI� vi�TGL� F,aOIlLI l TO DESTINATION STATE(IF REQUIRED)