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Please print or type„ ERI: can ar Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST ICAD981663iO7 (877) 577- 669 014903432 F L E <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Pep Boys #710 Pep Boys#71121 <br /> (c09) 464-6066 845 Dr. M.L. King Jr. Blvd 845 Dr.M.L.King Jr. Blvd <br /> Generator's Phone: Stockton CA 95206 Stockton, CA 95206 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Steric cle Specialty Waste Solutions Inc IMNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> ..5,,«— <br /> 8 Designated Facility Name and Site Address General Environmental Mgt, LLC U.S.EPA ID Number <br /> 11855 White Rock Road l7..�_l . ���'- <br /> Rancho Cordova, CA 95742 l 1 �7 ��^ <br /> Facility's Phone:9163510980 I b .?• CAD980884183 <br /> 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers r` 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity WLNoI. <br /> ., , Waste Aerosols, [flammable, (each not 2 CF 00016 P 814 D001 <br /> 0 exceeding 1 L capacity)] 2. 1, ERG#126 <br /> ad <br /> Z 2 <br /> W <br /> 0 <br /> 3, <br /> 4 <br /> 14.Special Handling Instructions and Additional Information 1 78375 Aero s o 1 s, Flammable) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are 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 expoq fsh�ment and I 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 identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> rators/Offeror's Printed/Typed Name Si IvkShth. Day Year <br /> .j International S pments <br /> t- ❑Importto U.S. ❑Export from L.S. Port of en (exit: E�. <br /> Z Transporter signature(tor exports only): Date lea n U.S.: 3 <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLJTransporter 1 Printed/Typed Name Sig lure , Month Day Year <br /> a Anthony Mack 101 115 T021 <br /> Z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 1- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity El Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) VU.S.EPA ID Number <br /> W-3)-ne-(02s 161 N <br /> LL va CAM 0 3 Z <br /> Facility's Phone: <br /> p <br /> W 18c.Si nature of Alt at Facili r Generator) Month Day Yea <br /> ZZ <br /> 19.Hazardous Wa ort Ma ement Method Codes codes for hazardous waste treatment,disposal,and recycling systems) <br /> 00 1. / / 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> CDA C:—m A7nn-T)lRov 1?_1n Prpuinim Pditinns are nhsnlete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />