Laserfiche WebLink
Please picot low' e.(Form'designed for use on elite(12-pitch)typewriter.) Form Approved-OM No.205MO39 <br /> UNIFQR(Jlf HAZARDOUS L Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE�MMIFEST CAL 0 0 0 3 3 0 4 2 3 1 800 4249300 018.17 0 3 4 a•J:J:K <br /> 5.GeneraWsi Name and Mailing Address Generator's Site Address(if different than mailing address} <br /> Q AND M,DBA TRACY CHEVROLET-QAN001 <br /> 3400 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Ge¢erato�s Phone: 209 835-4500 <br /> 6.Transporter 1 Company Name U.S.EPAID Number ' <br /> WORLD OIL ENVIRONMENTAL SERVICES C A D 0 2 8 2 7 7 0 3.6 <br /> 7.TTanspbrter2Comparty.Nairie US.EPA ID Number <br /> &.DWRriafed Fad xNahie and:SttsAddress U.S.EPA ID Number <br /> WORLD Ori:RECYCLING - <br /> 2000 N.ALAMEDA sTREE r <br /> COMPTaN CA- 90722 CATOSOOi335.2 <br /> Fadlm Phone: 01 WS-111-211 no <br /> ga, 9b.U.S.DOT Descriptron(trxA drag ProperShipping.Name,Hazard Class,ID Number, 1D.Containers 11.Tata) 12.Unit 13Waste Ggdes <br /> HM' . andPaoNngGm0(dany) ) No. Type quaniily Wtfvol. : • <br /> o "RQ-UN1893,WASTE FLAMMABLE LIQUID,N.O.S.,(GASOLINE; <br /> -one- <br /> DIESEL),'3,PG II I DMIF <br /> G. <br /> LU <br /> 3. <br /> 4 <br /> i <br /> 14.SpRCiaf•Handihrgfnstnrdions andAddrt orraFfgidtriiat[en :': <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#961:128*PROFILE#9B1: - <br /> 421,485 GASQUNE,DIESEL'* *,APPROPRIATE PPE,EQUIPMENT <br /> 15. OMMTONSIOFFERORIS C RTiFICR7IQH l homhy declare the#thec6nfentsdNiEarons iirpelr are fulftr,and soCurat<ly descr izsd above[s if=a psnpershlPPi►Lq narire,a9 i 'claszi dr `.: ' <br /> markad'aadbbetedfpigrrQ4?:ri0 irspoctsin prapercohd hnn fartrartsport adcartlgg,tu sppl[cflb!e irltemalfodatarid netianai.govemmerttai regufagonx if export sl��meidahil laiatl} <br /> Epp leU-f xrl[y <br /> 'ithe ntsglt3ii§ sigr>ipanlcon(orm lathe tarassaf tfse atfSehed EP'1�Jlcii�iatitiEedgmenlolt on5erjt <br /> frer57y.1heAthewas[emfl ffPn`sale+?riYJdentiS dIn4RCFR26Z2 7{�}[rftama-fargg4paif ygericrafar]or(b)[tli:31!a 4uanE .genMaw*lsh le - <br /> e rs! ucPsf? yp d. Si ture i4lddlti `�3aj�=•''(cal <br /> —� 1&:intemak�ohal6hlpirl$tsts' 0 hhpcltt tu lk <br /> ❑Evortfmm U S, Poltofe ritfyle <br /> w � - <br /> $ 3Yansporsignature(fore)pnrl�onty}; <br /> 17.TiansporterAdormdedgmentofRecefptaTlula6eri2gs _ <br /> LLI <br /> Timnspodw 1 Nntedf[yped Name Slgnabrra NTahlfi i _ _.rr <br /> 7ransportar 2 Pdntacnyp4d Name 5kdhature NleM " <br /> r _ <br /> 1B.Disrxepang .. '. _ • . <br /> 18a Dsrnepancy indlp�'on Space D Ouaiitity ❑ m 0 Residue O''?aiBal.Rejecti-on ❑F%EtejeCGikl:'. <br /> hfardW Referen Nnmher <br /> 19b:A1teris Fac&y(arG?rwr&0 U.S.Epi4iD'Nutnber :;s• ^; <br /> k Faditys•Phona: <br /> Uj <br /> 1ftSignatureofAltemawFat-Sy(orGeneraloo `fildnVr Day Year <br /> Q ' <br /> 19.Hazardous Waste RepoAvanagement Method Codes(Le.,codes forhazansouseraste-treatriieat,disposal,and Tgqng systems) <br /> T4. <br /> 20.Designated racifity Owperar Operator.Cartifxaflon of rec4l-of hkardonmatetiais Covered by ftmanifastonpt as nbled Kltom'18a <br /> PrintedfTyped Name signature htonfh Yrr:'` <br /> EPA Form 87f1U 22(Rev.3 05) Frevlous editions are obsolete. DESIGNATED'FACILITYTO:DESTINATION$TATE•(IF•RECIUIPIE <br />