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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) I'm Approved.0118 No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2,Page t of 3.Emergency Response Phone4,Manlfast Tracking Nnm er <br /> WASTE MANIFEST CAD 9 R 1 G 6 3 1 0 7 1 (800)4241-9� 00 018529053 0 J J K <br /> 5,Generators Name and Matting Address Generator's Silo Address(i€different than mailing addrass) <br /> PEP BOYS 400710 <br /> 201 E ORCHARD STREET" � : i <br /> HA(t<IMONTON NJ 08077 845 MAt-TI J I-�THEI,LING BLVD. <br /> Generators Ahow 209 464-6066 s i(.1 a]4 i r i E CA 95`06 <br /> 8,Transporter 1 Cempnny Name VS.EPA ID Number <br /> WORLD OIL ENVIP,t NP/1CidTAL SERVICES (,A D 0 2 8 2 1 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA$0 Number <br /> WORLDWIDE;RECOVERY SYSTEM INC. CAR 0 0 0 1 7 5 4 2 2 <br /> 8.Dasionaled Facility Name and Site Address U.S.SPA ID Number <br /> YUMAYES LLC <br /> ?730 E 13TH ST <br /> YIJ .AA. AZ 853155 AZR0O0515924 <br /> Facilihls Phone: (928)344-9928 <br /> 1l <br /> ga 9b.U.S.DOT Doscdplion(including Proper Shipping Name,Hazard Class,10 Number, 10,Containers 11,Total 12,Unit 13.Waste Codes <br /> t1 A and Packing Group(it any)], No, Type Quantity Wt1V01, <br /> & 1-NON-RCRA HAZ_ARDOOS WASTE SOLID(PAPER FILTERS) 352 <br /> 0 <br /> D ill P <br /> 2, <br /> w <br /> t7 <br /> 3. <br /> 4, <br /> 14.Special Handling instructions and Addilionat Information <br /> EMERGENCY CONTACT :cHEIV]TREC-11-600.42 :3300 WOWS TEPUVIINAL:CERE8 t;� �wI�r31 li.l; ��1 :1 C NRS-PEP358 <br /> PAPER FILTERS *APPROPRIATE PPE EQUIPNILNT <br /> 15, GENERATQR'StOFFEROR'S CERTIFICATION: l hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are ciassMed,packaged, <br /> marked and fabMedfplacarded,and are In all respects In proper condition for transport according to appllGsbte International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,i cert'that the contents of this consignment conform to the terms of the attached EPAAcknaaledgment of Consent. <br /> I certfy thattha waste minimization statement Identified in 40 CFR 262X(a)(if I am a large quantity generalor).or(b)(III am a amp uaribly generator)is Bue, <br /> ener r slOtferor s PdnledlTyped Name b1inature Month [lay Yeac <br /> 18;Intern anal Shipme. ❑import to U.S. ❑Export frarn U ori of enlrylexit: _ <br /> s Transporter signature(tor exports only); Da10 leaving U.S.: <br /> � 1T.Transports€P.:kno,NecgmanlgtFtecetplofMateriala <br /> Transport ttntedfTypa lame Signature Manch. Oat' Year <br /> a. <br /> Tra s T2 P'led ypepe ?gnature ton i} e h <br /> F- <br /> 18.Disc€epancy <br /> lea.01screpaney Indication Space11 puanuly ❑Type Elr3asid to ❑Partial Rejection r]Partial Rejection <br /> Manifest Reference Number: <br /> 184.Alternate Facik(or Generator] U.S.EPA ID Number <br /> U- FaciliVs Phone: <br /> 18c.Stgnalufe of Allemale Footing(or Generator) Monet Day Year <br /> � r <br /> 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 2. 1. 4. i= <br /> 20.Designated Facittly Ovrner or Operator:Cedif cation of receipt of hazardous materials covered by the manifest ept as noted in Item Ito <br /> PdnMed <br /> ii-LireFJ�ngth Day Year <br /> M {/!� 57 <br /> EPA Farm 8701)-22(Rev.3.05) Previous editions are obsotele. l ,;It?tN 1rC-D r-ACE I t Y T6 DESTIN,(1I'ION STATE(IF I EIrGlUIREI7) <br />