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111111111111111 Please nrint nr tvne /Fnrm dA..slnnP.d fnr IIRe nn Alin (12-nitnh) tVDewnter.1 Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STAW 'IF REQUIRED) 8700-22_12v3 CA20080057 S111 1741261167, M PD120318.--.Sa120318 UNIFORM HAZARDOUS 1. Generator ID Number CAD981662844 2. Pag 1 of 3. Erne enc Response Phone 87�i5�T7`669 14. Manifest Tracking Number 011392,89 F L E WASTE MANIFEST 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 1Company Name U.S. EPA ID Number Stericycle Specialty Waste Solutions Inc MNS000110924 7. Transporter 2 Company Name �.- ,.► U.S. EPA ID Number Q' 8. Designated Facility Name and Site Address 21st Century EMN, LLC U.S. EPA ID Number 2095 Newlands Dr. East Fernley, NU 89408 Facility's Phone: 779 ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. X1. UN1950, Waste Aerosols, [flammable, (each not 1 DF 00078 P 214 D00 0 exceeding 1 L capacity)] 2.1, ERG#126 I z 2. LU 3. 4. i 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 sW quantity general Generator's/ eror's Printed yped Name ff igna ure on ay Year ✓f /'%e/ / f1! v✓ Iq 01 201 [= 16.19riternational Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: Z Transporter signature for exports only): Date leaving U.S.: QZ 17. Transporter Acknowledgment of Receipt of Materials I- Transporter 1 Printed/Typed Name Signature Month Day Year Kristopher Almanza I I 14 04 20 CL Z Transporter 2 Printed/Typed Name Signature Month Day Year W- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residuejection ❑ Full Re' ❑ Partial Re lection Manifest Reference Number: 181b. Alternate Facility (or Generator) U.S. EPA ID Number J U Q �- Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year a z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typad.N=4 signatureM nth Ye EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STAW 'IF REQUIRED) 8700-22_12v3 CA20080057 S111 1741261167, M PD120318.--.Sa120318