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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 ID Number 2.Page 1 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 013 5 313 3 3 JJ K 5.Generator's Name and Mallin Address Generator's Site Address(if different than mailing address) Q AND M, DBA TRi�CY CHEVROLET-QAN001 3400 AUTO PLAZA WAY TRACY CA 95304 Generator's 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 8.Designated Facility Name and Site Address U.S.EPA ID Number WORLD OIL RECYCLING 2000 N.ALAMEDA STREET COMPTON CA 90222 CAT080013352 Facility's Phone: (310)537-7100 ga 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./Vol. ON1993,WASTE FLAMMABLE LIQUID, N.O.S.,(GASOLINE, DIESEL),3, 001 018 43 PG 11 DM !�4 G z 2. LU C9 �- 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#9131:128 *PROFILE#9B1: 426350 GASOLINE, DIESEL* *APPROPRIATE PPE EQUIPMENT - 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 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if 1 am a s2BIl quantity generator)is true. Generatoesl�f,[ors Pi dlTyped Name Signature Month Day Year x oY lf-r i x JL/Z �T 16.International Shipments t- ❑Import to U.S. El Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materials Transporter1 Printedfryped Name Signa Month Day Year aTransporter 2 Printedlfyped Name Signalure Month Day Year r- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue Partial RejectionRejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 G Nw 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(r ame Signature Month Day Year li-a 0 6-Q leZ EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FAC ITV TO DESTINATION STATE(IF REQUIRED)