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r <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pagelof 3.FanergencyResponse Phone --T4-—M.edest Tacking Number <br /> WASTE MANIFEST CAL 0 0 019 4 3 0 7 1 (800)424-9300 1 017 4 6 8 4 0 JJ K <br /> 5.Generatafs Name and Mailing Address Gonemtofs SiteAddmss(ddifferentthan mailing addmss) <br /> PEP BOYS#0562 <br /> 201 E ORCHARD STREET <br /> HAMMONTON 191 08037 1401 SOUTH CHEROKEE LANE <br /> Generator's Phone: 209365-0175 LODI CA 95240 <br /> 6.Transporter 1 Company Name 0.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 ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DEMENNO/KERDOON <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 CATO80013352 <br /> Facilitys Phone: (310)537-7100 <br /> 9a. 91b.U.S.DOT Desorption(Indudirg ProparShipping Name,Hazard Gass,ID Number, 10.Conta' he 11.TOW 12.Unit <br /> HM and Packing Group(Gany)) No. Type Quantity Willa. 13.Waste Codes <br /> 1NON-RCRA HAZARDOUS WASTE.LIQUID(BRAKE FLUID) 43 <br /> � DM 25 G <br /> z 2. <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional I:dammdon <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL: -*PROFILE#9B1:432037 BRAKE FLUID <br /> APPROPRIATE PPE EQUIPMENT ,1,[n nr(7 ( - I>(-,?oo <br /> 15. GENERATOR'SIOFFEROR'SCERnFICATION:I herebydedare that the contents of this consignment are Nay y <br /> and accurately e(bDo bythe pJmpershippirg name,and she classified,packaged, <br /> marked and labdedrplararded,and are in all mspgcts in proper conditonfortranspart=mEng foapplimlI einta hat onaland national governmental regulations.If erpodshipmentand 1 am the Primary <br /> Exporter,I tarty mat the contents ofthis Consignment mrform to the terms of the attached EPAACknaledgmentof Consent <br /> I certify that the waste minimization statement Mentified In 48 CFR 262.27(a)(if I am a large quantiy generator)or(b)(91 am a small quantirygenerator)Is true. <br /> n slOfterofs Printedfiyped Name5 n e Momh Day Year <br /> .r N r _-5 lot 0 lB' <br /> -� <br /> is,Internmonal Shipments <br /> f— ❑Impodto U.S. ❑6port from U.S. Poi afemry/etdb <br /> a Trnnspoder signature(for exports only): Date leaving U.S.: <br /> w 17.TanspoderAcknowledgment of Receipt of Materials <br /> Tmnspoder edRypedN a Sgnamre Month Day Year <br /> IL <br /> r 2 /o 10 21 L& <br /> 07 <br /> Q Transporter 2-fountedityped Name Y Sgnamm Month Day Year <br /> a <br /> r <br /> 4, 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Ouanliy ❑T e <br /> yp ❑Residue 0 Partial Rejed'wn ❑FWI Rejection <br /> Manifast ReferenceNumber. a <br /> 18b.Alternate FadRy(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Fa6lilys Phone: <br /> W 18c.Signature ofABemala Facility(arGenemtor) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes 0.e.,codes forbazardous waste veabment disposal,and recycling systems) <br /> C3 7. l„ 2. 3. 4, <br /> 20.Designated Facility Ovmer or0perator.Certification ofmceipt of hazardous materials covered by the manifest except as rated in Item 18a <br /> PdntetlRyped Name � ;IlM^ Mor&lei Signature <br /> / f Nt/ M Day 10 1 Z Year 1� <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />