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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator IDNumber 2.Page 1of 3,Emergency Response Phone 4.ManlfestTracking Number WASTE MANIFEST 016870463 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) TRACY CHEVROLET-Q&M INC 3400 AUTO PLAZA WAY TRACY CA 95304 Generator's Phone: 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 WORLDWIDE RECOVERY SYSTEM INC. 8.Designated Facility Name and Site Address U.S.EPA ID Number YES MANAGEMENT,INC. 6500 US HIGHWAY 95 YUMA AZ 85366 AZR000521146 Facility's Phone: '92$)344 9828 93. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. o NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) DM IOO P z 2. w 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT :CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#961:162623NRSQANOOI OILY SOLID, PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT 15. GENERATOR'131OFFEROR'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 labeledlplacarded,and are.in all respects in proper condition for transport according to applicable international and eguladons.if export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment m. I certify that the waste minimization statement identified in 40 CFR 262.27(x)(it I am a large quantity ge or(b)(if I am a small quantity ,tor)is true. Generator'slOUero d Name Signature Month Day Year X 3 Z� 1 16.Intemattonal Shipments F Import to U.S. Export from U.S Portof enirylextt: M Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Ttanspodf =nted/Typed Name Signature Month Day Year N � s C/0s E)3 r ZZ Transporter 2 Printed/Typed Name Signature Month Day Y air 18.Discrepancy ,18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue I ❑Full Rejectlon ❑ ❑Partial Re ecticn Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number . 0 LL Facility's Phone: Lu 18c.Signature of Allemate Facility(or Generator) Month Day Year a Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G1. 2. 3. 4: 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manife cept as noted in Item 18a PrintedlTypedNameSi atu M Day Year EPA Form 8700-22(Rev.3.05) Previous editions are obso ete. DES{GN D ACILITY TO DESTINATION STATE(IF REQUIRED)