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Please print or lype. 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 &A L 0 0 0 3 3 0 4 2 3 1 (800)4249300 020380612 JJ K <br /> 5.Generators Name and Ma:Tug Address Generator's Site Address(d different than mailing 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 4 2 2 <br /> 8.Deslgnated Facility Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMENT.INC. `• <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 AZR000521146 ' <br /> Facility's Phone: (928)344-9828 <br /> ga• 9b.U.S.DOT Description Qnduding Proper Shipping Name,Hazard Class,(D Number, 10.Containers 11.Total 12.UM 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity WLIVol. i <br /> "NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID) 52 <br /> DM �S� P <br /> z 2. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additlonal Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800.424-9300 WOES TERMINAL:CERES CS NAERG#961:171 *PROFILE#961: <br /> 162623QANCOI OILY ABSORBENTS * *APPROPRIATE PPE EQUIPMENT 9—ao )g, g x SS <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fulty and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeiedlplam ted,and are In all respells In proper co nd'dfon for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I car*that the contents of this consignment conform to the terms of the attached EPAAdcnowledgment of <br /> I certify that the waste minimiza4Eon statement identified In 40 CFR 26227(a) I am a large quantity generator <br /> proTof I am a small qujAty generator)is true. <br /> Generator yped Name S re Month Day Year <br /> 1 17 <br /> 16.Intemabon1MJMPfWrtr Import to ILS. ❑Export from U Port of entrylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAdurowledgmemt of Receipt of Materials <br /> LU <br /> Transporter 1 Pqntedaypedl NameSigrma Month Day Year <br /> i C IA41 C44n I ' C/ o 1 a t <br /> z <br /> are Month Day Year <br /> screpancy <br /> 18-Dlsaepa ndicatlon Space ❑ Quantity ❑Type Residue11i ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL. Faalitys Phone: <br /> in <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,dlsposa1,and recycling systems) <br /> LU 1. 2. 3. 4. <br /> 1 <br /> 20.Designated Fad¢ty or Operator.Ceffffcation of receipt of hazardous materials oovered by the manifest except as nqq in Item 18a <br /> r7odRyped Name Signature th Day Year <br /> EPA Form 8700-22(Rev.12-M Previous editions are obsolete. UDESI TED FACILITY TO EPA's e-MANIFEST SYSTEM <br />