Laserfiche WebLink
Please print or type.(Form designed for use-on elite(12-pt )typewriter.) Form Nproved,OMB No.205N 03R <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone d Manliest Tracking Number ��// <br /> WASTE MANIFEST GAL 0 0 0 3 3 0 4 2 3 1 800 424-9300 01,6868634 JJ R <br /> 5.Generator's Name and Mailing Address Generatbes Site Address(d different than maTmg address) <br /> TRACY CHEVROLET Q&M ING <br /> 3400 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> GeneratofsPhone. 209835-4500 <br /> 6.Transporter 1 Company Name U.S.FPA 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.I;PA ID Number <br /> WORLDWIDE RECOVERY SYSTEM ING. CAR 0 0 0 1 7 5 4 2 2 <br /> 5.Designated Facility Name and SltsAddmn U.S.EPA ID Number <br /> YES MANAGEMENT,INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 AZR00052li46 <br /> Fac5ty%Phone: <br /> 9a. 9b.U.S.DOT Desalp&wm(fndudtng Pmper SNpping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit <br /> HM and Paddng Group(dany)) No. Type Quantity Vlft IM. 13 Waste Codes <br /> Le �OWRCRA HAZARDOUS WASTE,SOLID(OILY SOLID,PAPER FILTERS) 52 <br /> r D M 7c P <br /> u1 <br /> �t 2. <br /> w <br /> +:n <br /> 3. <br /> 4. <br /> 14.Spada]Handlurg Instructions and Add iftmd InformaWn <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *-PROFILE#951:162623NRSQANOOI <br /> OILYSOUD,PAPER FILTERS* *APPROPRIAITE PPE EQUIPMENT <br /> -744 mor e 3 XS'5`- . <br /> 15. GENERATOR'SfOFFMMS CEK11FiCATION:I hereby dedare gnat the rantents of this consignment are ruliyerrd accmafefydesortbed abmre itr Erg nam%and ere dam,packaged. <br /> marked and labeledfp]aearded,and am In all res mcb;In proper cond a fortransport according tvapp*rcabla fntcmat anal on ommerdaf regulations if shipment and I mn the Primary <br /> Exporte,IcerGfythat the wtUal'3ofth�co*nmentcorArmtothe team ofiheatt edEPA Aumomedgm nL <br /> I certly that the wade r 9ftzarmn tidentlaed In 40 CFRM27(a)(f I am a Paige quanfflyge or or(b){f t am a sma7 quantity generator)is tro <br /> GeneratoeXf[eroeo Slgnatume Manch Day Year <br /> 1&.inlarirativnalShlpmerds �kpotttoU.S. ❑EZort tromU.S entryfeaot V <br /> r— , <br /> Tmnsporler slgnatura(foranpods onty); ieaving U.S.: <br /> w 17.TransporterAdamoviledgrnent ofRectV of M Wals <br /> Trans 1 Printo&Typdd Name natu imfonlh Day Year <br /> Cg19 <br /> Transportar2 PdntedfFypedName Sig month Day Year <br /> to,Disaepanry <br /> 18a.Discmpancy lndication Space D amu, ❑Type ❑Residue ❑Partial Rejection ❑ u Re)ec6on <br /> Ma6lest Reference Number. <br /> G talxAft2mate Padfdy(crGeaerator) U.S.EDAM Namber <br /> U <br /> Fat:ili A Phone: <br /> 18C,Signature ofAltemale Fadity(or Gemraforlhl vrrlir Day YM <br /> kc <br /> U5 19.Hazardous Waste Rep N[anagement Metimv PCad Hs a codes for hazardous waste treatmerd,disposal,and recydingsyslems7 <br /> 0 1. 12, <br /> 3. b. <br /> 20.11 ed FacrTity Owner or Operator 2e n of receipt of 4azardores materials covered by the manifest except as noted in Item 18a <br /> dnwd Name Sign Month Day Year <br /> EPA Form 8700-22( evious edbr'ons are obsolete. DESIGNATED FACILITY TO DEST[Ik aft STATE(IF REQUIRED) <br />