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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 017696223 J J <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> TRACY CHEVROLET-Q&M INC <br /> 3400 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Generator's 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 01 7 5 4 2 2 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YUMA YES LLC <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 AZR000515924 <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(if any)) No. Type Quantity Wt.Noi. <br /> 0 1' NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) <br /> g DMI P _.__.. <br /> Z 2. <br /> LU <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#9B1:162623NRSQAN001 <br /> OILY SOLID, PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT <br /> z-o <br /> 15. GEN ERATOR'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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I,certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I 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 a small quantity generator)is true. <br /> Gener ed Name Signature M t Day Year <br /> X <br /> 16.International <br /> j_ Import to U.S. Export from U.S. Port of entrylexit: <br /> z Transporter signs \(fexports o ty). Date leaving U.S.: <br /> w <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Trans o0 1 Printed/TypeddL <br /> (ignatu Month Day Year <br /> a e t ` 1/ 7-1/3 <br /> me me Sig atur Month Day Ye <br /> ansp <br /> � e <br /> 18.Discrepancy <br /> 18a.Discrepag ndication Space Quantity iType ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> A 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 12 <br /> T- <br /> LLJ 4. <br /> l r <br /> 20.Des g ated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printe ped Name, Sig(nat e Month Dayyy lYear <br /> - ' <br /> EPA Form 8700 22(Rev.3-05) Previous editions are obsolete. D 9SIG NATE DI FAChACY TO DESTINATION STATE(IF REQUIRED) <br />