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Please print or type.(Form designed for use on elite(12-pltch)typewriter,) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifestTrackingN�uum-beer�+ <br /> WASTE MANIFEST n I C;n 0.% '4 n 4 9A 'i" !30(11 A24-9300U `] 1 V O JJK <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> TRACY CHEVROLET-Q&M INC <br /> "40.0 AUTO PLAZA VVAY <br /> TRACY CA 95300 <br /> Generator's Phone: 209 935-4500 <br /> S.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL EN14RONMENTAL SERVICES C AD 0 2 8 2 7 7 0 3 6 <br /> 7.Transpoftr 2 Company Name U.S.EDAM Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number. <br /> GEMENNO l KFRDOON <br /> 2000 N.ALAMEDA STREET <br /> CO3MPTON CA 902.22 CAT08001.3352 <br /> FacilitysPhone: a a <br /> ga. .9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WtJVol. <br /> tic1'UN1993,WASTE FLAMINIAFLE LIQUID, N.O.S„(GASOLINE', DIESEL), 3 <br /> PG II DM G <br /> w <br /> 2. . <br /> w <br /> 3. <br /> r <br /> 4. <br /> 14.Special Handling Instruction and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC .1-800-424-9300 WOES TERMINAL:CERES CS NAEP,G#9S1:y?8 "PROFILE#9S� <br /> 428350 GASOLINE,DIESEL* *APPPOPP.IA"E PERSONAL PROTECTIVE EQUIPMENT of q 1)(5s-- <br /> 15. <br /> j(5s--15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedam that the contents of this comigrument are f gy and accumMy 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 intemaf[onal and national gvvemm regulat ons.llexport shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenf of Can%nl <br /> I certify that the waste m on statement identified in 40 CFR 26227(a)('d I am a large quantity generator)or h r m a surall quantity ge is we. <br /> Ge ralor'efOK rnikedrfype Name 9 Month flay Year <br /> 106f 1110 <br /> t8.lutematio e <br /> I-- Importto.U.S. �Export from U.S. P fentryfexit: <br /> Transporter signature(for exports only): Data leaving U.S.: <br /> 17.TransporterAcknoMedgmerd of Receipt of MalerWs <br /> TranIr <br /> Mr Print"dIff Nama Signature Month Day Yeas <br /> Aar 06 r <br /> d Transporter 2Printe ITy Name Signature Month Day Year <br /> f` <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 1Bb.Alternate Facility(or Generator) U.S.EPA ID Number <br /> ..r <br /> U <br /> u�. FacTlyrs Phone: <br /> LU 18c.Signature ofAllemate Facility(or Generator) Month Day Year <br /> d <br /> 19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> PrintedlTyped Name Signature Month Day Year <br /> v <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />