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i, <br /> is <br /> Please print or type,(Form designed for use on elite(12-pitch)typewriter,) Farm Approved.OMB No,2050.0039 <br /> UNIFORM HAZARDOUS 11.Generator ID Number 2.Page t DI 3,Emergency Response Phone I Manlfest Track€n Number <br /> WASTE MANIFEST CAD 9 8 1 6 6 310 7 3 0 Q <br /> 8 0 4249300 <br /> � �. 5�2 9 . 3 8 JJK <br /> 5.Generators Name and Mailing Address Generator's Site Address(f(different than mailing address) <br /> PEP BOYS#0710 <br /> 201 E ORCHARD STREET <br /> HAMMONTON NJ 08037 845 MARTIN LUTHER KING BLVD. <br /> Generator's Phone; 209464-6065 STOCKTON CA 55206 <br /> e.Transporter i Company Name U'S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U,S,EPA IP Number <br /> i? <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DEM ENNO/KERDOON <br /> 2000 N.ALAMEDASTREET <br /> COMPTON CA 90222 CAT 0 8 0 013 S 6 2 <br /> �a <br /> Faciilys Phone: (-510)537-7100 <br /> is <br /> ga. 34.U.S.DOT description(including Proper Shipping Name,Hazard Gass,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and ParkingGroup(i{any)) No, Type Ouenlily WidVol, <br /> 1NON-RCRA HAZARDOUS WASTE, LIQUID(BRAKE FLUID) 343is <br /> DM �� G <br /> u.r <br /> 2, <br /> c� <br /> r <br /> 3, <br /> a. <br /> .r" <br /> 14.Special Handling Instructions andAdditienal Information <br /> EMERGENCY CONTACT.CHEMTREC 1.-800-424-9300 WOES TERMINAL: *PROFILE##9131:415019 BRAKE FLUID <br /> APPROPRIATE PPE EQUIPMENT <br /> K"3d <br /> 15. GENERATOR'SIOFFEROR'S CERrifICATION:I hereby declare that the contents of this consignment are fully and aauratelydescribed above by the proper shipping name,"are classified,packaged, <br /> marked and laboledlplacarded,and are in all respects In propor condition for transport a=rding to applicable Intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment con€orm to the terms of the attached EPAAcWovdedgmentof Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 2U.21(a)(flam am alarge quantity generator)or(b)(if I am a small antitygenerator)is true, <br /> vera eslOfferoes Prinleddfyped Name Igna Month Day Year <br /> b <br /> -� 16.Intamaticna€srupmenl <br /> F ❑Import to U,S. ❑Export ho Port of enhyleid <br /> Transporter signature(forexporis only): Dale leaving U. .. <br /> LW 17.TransporterAcknowtedgmentofReceipt ofMateriais <br /> TransportMIntedfTyped oma Signature Month Day Year i- <br /> Transpodi Printed/Typed Name Signature Month Day Year <br /> F- <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Typa ❑Residue ❑Parfiah Rejection ❑Fuil R*cBon <br /> Manifest Reference Number. <br /> 18b,Aftemate Facility(or Generator) U.S.EPA 10 Number <br /> 1 <br /> c� <br /> i' <br /> LL FacilitysPnone: <br /> Lu 180.5fgnature ofAltemale Facility(or Generator) Month Day Year <br /> is <br /> 19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardouswasie treatment,disposal,and recycling systems) <br /> do is) /�� 2, 3, 4, <br /> & eDesignaled Facility Owner or Operator;Certification of recelpt of hazardous malerlals oovered by the manifest except es nded In Item 18a <br /> PrintedfrypedName. Signature Month Day Year <br /> I4 Ori SPS jC1 D$ <br /> EPA Farm 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />