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Plbase print Formdesi ed for use on pitch) IAI �118111INI�l�lll�ll� 1HI�II� <br /> P h'Pe�( 9n ( F» )typewriter.) Form Approved.OMB No-2050-0039 <br /> UNIFORM HAZARDOUS i.Ge mbm ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifestTrackin9 Number <br /> WASTE MANIFEST CAL000194307 1 8775772669 009156056 FLE <br /> S.Generelors Name and Mating Address Generator's Site Address('dditerernmen naming address) <br /> Pep Boys #562 Pep Boys#562 <br /> 2Q9�6 75 . 14M S Cherokee Ln 1401 S Cherokee Ln <br /> Generators Phone: Lodi, CA. 95240 Lodi, CA 95240 <br /> U. ranspmler me <br /> parry a <br /> U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS00O110'724 <br /> 7.Tramputer 2 Company Name U.S.EPA ID Number <br /> B.DesgnatetlFapliy Name antl SteAtldress General Environmental Mgt, LLC U.S.EPA 11 Number <br /> 11655 White Rock Road <br /> Rancho Cordova, CA 95742 <br /> Facltly's Phone- 9163510980 CRD980884183 <br /> 9a. 9h.U.S.DOT Description(tndWmg Proper ShippingName,Hazard Class 10 Number, 10.Containers <br /> 11.Trial 12.Unitidany)) No <br /> HM and Packing Gkoupf . Type Quantity WtNol. 13.Wame Codes <br /> X +. UN1850, Waste Aerosols, [flammable, (each not I CF 00018 P 21 D00 <br /> exceeding I L capacity)] 2. 1, ERG#126 <br /> U <br /> Z X 2 UN1760, Waste Corrosive liquids, n.o.s. 1 CF 00023 P 12 D00 <br /> (Sodium Hydroxide, Sodium Hypochlorite), 8, <br /> PG II ER6#154 <br /> 3 Non RCRA hazardous waste, liquid (Auto Care i DF 00075 P 33 <br /> Products), <br /> 4. <br /> 14.Spedu Handling Instructions antlAdditonm lnfurrhaton 1.78375(Aerosols, Flammable) 2.78886(Basic Liquids, Corrosive) <br /> 3,78411 (State Regulated Liquids) <br /> 15. GENERATOR'S/OFFEROWSCERDFICATION: I hereby declare that the contents of this consignmentam Nllyand accuratelydeunbed alwve by the p shipping name,and are rdassified,packaged, <br /> marked and labeled/placarded,aril alateall respe�in proper aadition for transport acmrdtgWapplicable international andnational govemm0 ations.If export sMpment andlam the Primary <br /> Exporter,l certify that the contents of this coragnrnentcontomh to the leans ofihe attached EPAAcknoWledgmem of Consent. <br /> I candy that the waste minimization statement identified in 40 CFR 26?27(a) I am a large quantly generator)or(b)(if i am a small qua g a <br /> t ro s nn ypetl Na ♦ re <br /> f y ear <br /> a l ; 0 1 <br /> 2017 <br /> I matona.S ms ` <br /> 2 <br /> LJ import to U.S. El Evart f.U.S. 0of entry/exit <br /> Transporter Sinature far exportsoN : Date leaving US.: <br /> w 17,TranspfampAckh WedgmentofReomptof Materials <br /> E2 Transputer I Pdnted/Typed Name S11gnalure <br /> IL <br /> Johnny Harper 0 ill 20 7 <br /> TruhspWar2 PdmedRypam <br /> ed Ne Signature� Day ear <br /> r— <br /> Till.Discrepancy <br /> 18a,Discrepancy Indication Spam OQhenfity ❑TYP. ❑Residua ❑Panel Rejection El Fall Rejection <br /> Manifest Reference Number: <br /> �. 18b.Altemare Fardtty{orGerheraiu) U.S.EPA ID Number <br /> J <br /> v <br /> LL FatiG s Phone: - <br /> r0 18c.Sgnature ofAltemam Faclrdy(or era mtor) Month Day Year <br /> 4 <br /> 2 <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,cedes for hazardous waste treatment,disposal,and recycling systems) <br /> 01. 2. ry1 <br /> 3. q <br /> 20.Designated Faulty Qwneror Operator;Cmfifax' ptofhumdous matmials covered by the manifest except astorted i Ilam <br /> Pdnted/Typed Name , SgnaNreMonth Day Year <br /> EPA Forth R7DD-22(Rev.3 05) ev ous ed ons are obsolete. DES! HATED FACILITY TO DEST)NATfnN STATE(IF REQUIRED) <br />