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A <br /> Pease print or type.(Form designed for use on elite(12ppitch)typewriter.) <br /> F <br /> orre Approved.OMB No,2ll5U O039 <br /> UNIFORM HAZARDOUS 1.Cane alar ID Number 2.Rage 1*f 3,Emergency ResponsePhnne 4 I�aniiaat T{ra�cklnprN]um��*ber ��(( <br /> WASTE MANIFEST CAD 9 816 6 31 0 7 1 (800)4248300 V L U 10 JJ K <br /> S.Generators Name and Mall Address Generators SBe Address fd ddfem i than rnatktg address) <br /> PEP BOYS�f0710 <br /> 201 E ORCHARD STREET <br /> HAMMONTON NJ 08037 845 F_CHARTER WAY <br /> cencK"s Phono: 20946+6o66 STOCKTON CA 95206 <br /> S.Transporter i Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES <br /> eAD028277036 <br /> 7.1 ranspgrter2 Company Name U3,EPA ID Number <br /> 8,Des, <br /> gnatad FeaNty Name and Ra A4ciress U.S.EPR ID Number <br /> US ECOLOGY VERNON INC <br /> 8375 SOUTH 130YLE AVENUE <br /> L05 ANGELI CA 90058 <br /> Foal rys Phone: (323)277-1500 CA 097030993 <br /> ga. 9b.U.S.COT Destuptian(ndudtg Proper Sft A*ig Nene,Hazard Claga,ID N4rmbef, 10.Containers f 1.Tidal 12.USI <br /> HM ung Cxoup(danY)1 No. Type Ouandly WINd, 13.Waste Codes <br /> 1 UN2794,WASTE BATTERIES,WET,FILLED WITH ACID.8 <br /> f D002 D008 792 <br /> P <br /> LU <br /> 3. <br /> 4, <br /> If. <br /> X.SpecW Handling irrstnrctorts and Addid.1lofamation <br /> EMERGENCY CONTACT'CHEMTREC 1-500-424-9300 WOES TERMINAL CERES CS *PROF=ILE#9B1:05082019-01 �y <br /> BATTERIES WET FILLED WITH ACID *P500.00076259*APPROPRIATE PPE EQUIPMENT W-57 1)(20 <br /> 15. GENERATOWMFFEROR18 CVMFICATION:I hefeby dedare that tits omtenI3 of this ronslgnumnt are fuly and amnlOydescribed above by the proper shipping name,arta are dasskd,pecka9ed, <br /> markod and fabeladrgfa=ded,and are in all respecbt fn pmW oxici t hxtrznspettacxordlrg to applicable intematiotatarrd naDonal90 mawntei raagutations.ll sfvprfaerd and t am Ta Priasa y <br /> Expoden t M'fy that tho cmntent5 of tris oalmiPnwt mrafoml b the terms of ttse attached EPAA.dmwkxlgmattt of Consent, <br /> I am*that the Trade m rikNzabOn atalemahl kientlW h 40 CFR 262 27(a)(if I am a"Quantity generator)dr(b)(dl ap a-mail carr*ganerelor)is vtre, <br /> fsPrinedlTyped re 6lonlh Day yftrr� <br /> � ! <br /> a T4.fnleraaaonal Sh' L{ <br /> rrartsporlar s grebtre{for pxpgrts Eli. <br /> Im m U.S. ��L]Ewtfwu.V_ <br /> Pod c foot <br /> hate virg U.S.: <br /> w 17.TranspalwAdotatsiodgm(ddRec ptdLWedafs <br /> TraT ftt&T Na Sign�tue Marsch Day Year <br /> fo0. <br /> Trull w2mradrtyped Vine89nature Month Day Year <br /> H <br /> 18.Oisuapartcy <br /> 1$a.tkscrepar cy Ind cation Specs El Chrsntity ❑Type ❑Residue ❑Partial Reed. ❑Full Re ecticfa <br /> MaNfeat Reference Number <br /> 18b.Anm tO Fealty(or%roemtor) <br /> U.S.EPA ID Nwrt6er <br /> LL Feat"Pvft. j <br /> 1Sc.Sgrtalure ofAllamaw Fadiity(Of C'enaratof) Mar tta W Year <br /> d y <br /> CD <br /> tg,Hazaadwa Walla Report f ba sago Codas{i.e.,ondes Fx baianlbus waste lreatrnen(disposal,and recydng systems) <br /> IfJ 1 <br /> " 2. 3- a. <br /> 20.Destgnaled Faddy a Dpera -SertirwarFo+s of racetpt of hazardous rawttoriels covered bylha manilestaxc ept as ncted in Rem 18a <br /> P yped Nems Signahug MOO Dayear <br /> xE vv <br /> 7 01 119 <br /> EPA Farm 870422(Rev.3-)5)PrevibuB editions are olualete. DESIGNATED FACILi7Y TO DESTINAT STATE(IF REQUIRED} <br /> H, <br />