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a" <br /> AN <br /> Pif"W"i"13661 o'r type.(Form designed _^UNIFORM <br /> HAZARDOUS <br /> AN EST r Gene Generator <br /> D Number-P <br /> Pitch)t pewnter. <br /> 5.Generator's N C A B Form Approved,OMB No.2050-0035 <br /> PEP BOYS d MT n Aedrese 8 1 6 6 2 8 4 4 2,Page 1 0l 3.Erne gen y Response Phone �.Ma Int Tpoking NumGr <br /> ME N I 1 (800)424-s3o0 `j 0055 JJ K <br /> NA STREET Generalofs Sire Address(d diRerenr than madmg address) <br /> Generators phone; <br /> n Tans <br /> ,ter 1 Com 2b8 852.1222 Ni 08037 <br /> eany Name 4987 WEST LANE + <br /> ORLD OIL ENVIRON STOCKTON CA 95210 , <br /> 7 TransW6.2 2 Com an MENTAL SERVICES <br /> �VORLD1�If�E R U S.EPA ID Number <br /> CAD028277036 ? <br /> e.Desl{g/na�iad Facili COVERY SYSTEM INC. T <br /> `�'MANArr`�and Site Address U.S.EPA ID Number <br /> ME CAR000175422 <br /> YUP US HIGH WAY 95 C <br /> U.S.EPA ID Number o <br /> 1 <br /> Facility's Phone: AZ 85365 D, <br /> sa. sb.U.S.DOT D(928)344-9828 <br /> escnptionu, A Z R 0 00521146 <br /> HM p(if any)) Shipand Packing Group ( Guding Proper ping Name,Hazard Class,ID Number, <br /> 0 1 NON-RCRA HA�RDOUS 0.Containers 1.ental 12.unit <br /> No. Type Quantity WINoI. 13.Waste Codes <br /> WASTE.SOLID(PAPER FILTERS) <br /> CkcLU <br /> 352 <br /> w 2.NON RCRA H D M Z� P I c <br /> CD AZARDOUS WASTE <br /> SOLID(BRAKE LATHE SHAVINGS) – <br /> �F ' <br /> 1a1 <br /> 3 <br /> 4 <br /> 14.Special Handling Instructions and Additional Information _ <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAEGM 981:171.9132:171*PROFILE M <br /> 981:161623NRS-PEP359 PAPER FILTERS,9B2:1710395NRS-PEP359 BRAKE LATHE SHAVINGS* *APPROPRIATE PPE <br /> E UIPMENT <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,aMare classified,packaged, <br /> 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 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identirred in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is We. <br /> Gepara)oce/Offerors Printed/Typed Name Signature Month Day Year <br /> 19' <br /> J 16.International Shipments <br /> Z ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w17.TransporterAcknowledgment of Receipt of Materials <br /> JTr/a9spo erer 1 Printed/Typed Nay* Month Day Year <br /> Qz Transporter Printed/Typed Name c Slgnatu e-f/-7 ,!v—� Month Day Year <br /> Of <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL- Facility's Facilitys Phone: Month Day Year <br /> W 18C.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 <br /> 1. <br /> 2 3. <br /> 20,Designated Facility ner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 182 Month Day Year <br /> Signature <br /> Printed/Typed Name <br /> i J i <br /> DESIGNATED FACILITY TO GENERATOR <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> k <br /> 711 UHWM 018170055JJK TSDF <br />