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Please print or type.(Farm designed for use on stile(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I.Generator ID Number 2.Page 1 of 3.Emargancy Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAD 9 816 6 310 7 J. (800)424-930a Q 17 4 6 8 14 JJK <br /> S.GenaretoPs Name and Ma€Iing Address <br /> PEP BOYS#0710 Ganeratot s Site Address(€i different Uieri mafllrig address) <br /> 201 E ORCHARD STREFT ' <br /> HAMMONTON NJ 08037 845 MARTIN LUTHER KING BLVD. <br /> GenaratorsPhone: 209 464.6066 STOCK'TON CA 95206 <br /> S,Transporter 1 Company Name <br /> U.S.EPAID Number I' <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3.6 <br /> 7.Transporter 2 Company Name U.S.EPA€D Number <br /> WORLDWIDE RECOVERY SYSTEM INC, CAR 0 0 0 3 7 5 4 2 2. <br /> B,Destgrialed Facility Name and Silo Address U.S.EPA ION-umbar <br /> YUMA YES LLC <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 A Z R 0'0 0 515 9 2 4. <br /> Facility's Phone: (928),344-9828 <br /> ga, Sb.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1t Tolal 12.Unit <br /> HM and Packing Group Of any}) No, Type Quantity WWo€, 13•Waste Codes i <br /> IKON-RCRA HAZARDOUS WASTE SOLID(PAPER FILTERS) <br /> 352 <br /> o <br /> D M 2—a P <br /> LU z. <br /> c� <br /> 4. <br /> 14.Spadal Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHCMT REG 1-800-424-9300 WOES TERMINAL: *PROFILE#9BZ:161623NRS-PEP358 PAPER <br /> FILTERS * *APPROPRIATE PPE EQUIPMENT <br /> 15. GIENERATOWSIOFFEROR'S CERTIFICATION: i hereby declare that the contents of IhN consignment are fully end acarratelydescribed above by the proper shipping name,and are dassffled,packaged, <br /> marked and labeledlplacarded,and are In all respects In proper condition for Uansport according to applicable intemo0onal arid naflonal governmental regulallons.If export shlpmant and I em thg Pini <br /> Exporter,I carllfyihat the contents of[his consignment conform Io the terms of the attached EPAAcknWedgment of Consent, <br /> I corflfy that the waste minimization statement identtbed In 40 CFR 261 Of I am a large quani generator)or(b)(I m a small pantily ganefator)is M. <br /> n o��Ifetto��nledlT mo � ign a, 4�f <br /> Month Day Year <br /> J a Z <br /> —r 16.tnle allonal5hlpmonis <br /> F ❑Impart to U,S.' <br /> z ❑Export from U.S. rylexfl: <br /> -- Transporterslgnature(foraxparts only): Data leaving U.S.: <br /> 17.TrampoderA4mowiedgmant of Recolpl of Malodals <br /> Transport nlodlTyp Name Signature Month Day Year. <br /> a <br /> Transporter 2Fr1nt*d/fype Naml Signature Month Day Year <br /> 1s. isrrapency <br /> lea.Discrepancy IRdicaltan Space <br /> ❑ Ouanuty ❑Type ❑Residue ❑Padial ReJadton ❑Fug Refectan <br /> Manifest Reference Number: <br /> fab.Altemato Facility(or Generator) U.S.EPA ID Numbar <br /> V <br /> Fadhtys Phone: <br /> in LU <br /> 18c.signature afAllemateFacility(or Genera <br /> ior) Month Day Year <br /> L9.Hazardous Waste Report Management Method Codes(.s.,codas for hazardous waste treatment,disposal,and recycling systems) <br /> a I• 2. 3, 4 <br /> 20.Designated Faciilty owner or Operator,Cerllflcadon of receipt of hazardous maladals covered by the man€feel except as nded in Item lea <br /> t'rintedlTypedName 5tgna� Man Day Year <br /> iPA Form 8 00.22Previous edtflons are obsolete. DES1G A ED CILITY TO DESTINATION STATE(IF REQUIRED) <br />