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Form Approved.OMB No.2050-0039 <br /> Please print or type. <br /> 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking N <br /> UNIFORM HAZARDOUS 1 1 (877) 577-2669 014374" 845 4 F L E <br /> WASTE MANIFEST CAD981663107 <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 /> Generator's Phone: Stockton CA 95206 St o k t o n CA <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> pecialty Waste S lutions Inc <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> 8.Designated Facility Name and Site AddressU.S.EPA ID Number <br /> General Environmental Mgt, LLC <br /> 11855 White Rock Road <br /> Rancho Cordova, GA 95742 <br /> Facility's Phone:91635109$0 <br /> 9a. <br /> 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> X ON1950, Waste Aerosols, [flammable, (each not 1 CF 00008 P 214 `D001 <br /> a exceeding 1 L capacity)] 2. 1, ERG#126 <br /> z 2. <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information 1.7$375(Aer o s o 1 s, Flammable) <br /> 15. GENERATOR'S/OFFEROR'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 I am a large quantity generator)or(b)(ifI am quantity generator)is true. <br /> Generators/Off eror's PI d/Typed Name <br /> Signature Month Day Year <br /> 04 130 '020 <br /> 16.International Shipments El Import to U.S. ❑Export from U.S. o f entry/exit: <br /> ? <br /> Date leaving U.S.: <br /> Transporter signature(for exports only): <br /> W17.Transporter Acknowledgment of Receipt of Materials Month Day Year <br /> Transporter 1 Printed/Typed Name Si <br /> a Isidro Martinez 04 30 020 <br /> Z Transporter 2 PrintedlTyped Name <br /> Signature Month Day Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> J <br /> U <br /> I Facility's Phone: Month Day Year <br /> OL 18c.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. t ' 2' 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a 8700-22 Rev.12-17 Mon h Day <br /> 1 (6 <br /> EPA Form ( Year <br /> PrintedlTyped Name �\ Signature <br /> Previous ed li oFAC <br /> ns are obsolete. /��` DESIGNATED ILITY TO E A's a-MA IFEST SYSTEM <br /> ) <br /> 8700-22 12v3 CA20080057 511099 041758208 M PD043020 - SD043020 - - <br />