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II IIII�II�III��I�II�III�I�11 I Approved.OMB No.2050-0039 <br /> ER Form Appro <br /> Please print or type. 4.Manifest Tracking Number <br /> =Gener�at;orr 2.Page 1 of 3.Emergency Response Phone 9 FLE <br /> UNIFORM HAZARDOUS1 (877) 577-2669 0144044WASTE MANIFEST 3107 <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Pep Boys #710 Pep Boys#710 <br /> (209) 464-6066 845 Dr.M.L.King Jr. Blvd 845 Dr.M.L.King Jr. Blvd <br /> Stockton, CA 95206 Stockton, CA 95206 <br /> Generator's Phone: U.S.EPA ID Number <br /> 6.Transporter 1 Company Name MNS000110924 <br /> Stericycle Specialty Waste Solutions Inc <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> 8.Designated Facility Name and Site Address <br /> General EnvironlpIE!n a , U.S.EPA ID Number <br /> 11855 White Rock Road <br /> Rancho Cordova, CA 95742 CAD980884183 <br /> Facility's Phone: 9163510980 <br /> 9a 91b.G.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM <br /> and Packing Group(if any)) No, Type Quantity Wt.Nol. <br /> X 1UN1950, Waste Aerosols, [flammable, (each not 1 CF 000^c2 P 21 D00 <br /> exceeding 1 L capacity)] 2. 1, ERG#126 <br /> W <br /> Z 2. <br /> U1 <br /> c9 <br /> 3. <br /> 4. <br /> i' <br /> 14.Special Handling Instructions and Additional Information 1.78375(Aerosols, 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 export shipment 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 1 am a large quantity generator)or(b)(if I am a small quantity generator)is true. Month Day Year <br /> Generator'sloffer is PrintedlTyped Name Signature <br /> 14 21 2020 <br /> 16.International Shipments �Import to U.S. ❑Export from U.S. Part of entrylexit: <br /> Date leaving U.S.: <br /> Transporter signature(for exports only): <br /> W 17.Transporter Acknowledgment of Receipt of Materials Month Day Year <br /> LU <br /> Transporter 1 Printed/Typed Name Signature <br /> a Kristopher Almanac Month Day Year <br /> Z Transporter 2 PrintedlTyped Name Signature <br /> Q <br /> E18a. <br /> ancy <br /> pancy Indication SpaceQuantity TypeResidue Partial Rejection Full Rejection <br /> Manifest Reference Number: U.S.EPA ID Number <br /> . nate Facility(or Generator) <br /> J <br /> QMonth Day Year <br /> u Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems 4 <br /> 0 1 2. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest <br /> suexcept as noted in Item 18a Month Day Year <br /> Printed/Typed Name 1 Z <br /> EPA Form 8700 22(Rev.12-17) Previous editions are obsolet . DESIGNATED F ILITY TO EPA's e-MANIFEST SYSTEM <br />