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Please print or tvpe. (Form desioned for use on elite (12 -Ditch) tvoewriter.) 111111111111111 Form ADoroved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. J DESIGNATED FACII-r DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAD981662844 1 8775772669 1 011386935 F L E 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Pep Boys #711 Pep Boys#711 2099521222 4987 West Ln 4987 West Ln Generator's Phone: Stockton, CA 95210 Stockton, CA 95210 6. Transporter 1 Company Name U.S. EPA ID Number Stericycle Specialty Waste Solutions Inc MNS000110924 7. Transporter 2 Company Name/�^► U.S. EPA ID Number 8. Designated Facility Name and Site Address 21St C nt ury , LLL U.S. EPA ID Number 2095 Newlands Dr. East 7 -if 5-7.rz -nk.,r Fernley, NV 89408 Facility's Phone: KIIIIIIN!N 0403R '20 9a 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. X 1.UN1950, Waste Aerosols, [flammable, (each not 1 CF 00004 P 214 D001 0 exceeding i L capacity)3 2.1, ERG#126 Z 2. w 3. 4. 14. Special Handling Instructions and Additional Information 1.78375 (Aerosols, Flammable) 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 EPA Acknowledgment 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 I am a small quantity generator) is true. ener r'stOfferor's Printed/Typed Name signature on ay Year 7! F- 11. Intemational Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name t Month Day Year a z Transporter 2 Printed/Typed Name Signatum Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space ❑ QuantiEl ty Type El Residue El Partial Rejection El Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U LL Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) LU 1. 3. 4. ; 12. 20. Designated Facility bwner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrryped Name Signature MonthDay Year jal/91 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. J DESIGNATED FACII-r DESTINATION STATE (IF REQUIRED)