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Form Approved.OMB No.2050.0038 <br /> -Tease print ohype.(Form designed for use an elite 42 itch)typawriter.)\ <br /> UNIFORM HAZARDOUS 1.Generator iD Number 2. age 1 of 3_Eme3gency Response Phone 4,ManlfestTrackfng Number_ <br /> WASTE MANIFEST •.. .t3 0 7.4?4' 0% BQIO 42 H � e '., �� <br /> 5:Generator s Name and Mailing Address Generatots Site Address(il different than mailing address) <br /> PEP BOYS Row <br /> Q01 E ORCHARD STREU <br /> 'HAMMONTON IBJ 08087 :L403,SOU r4 CI)OEC?€EE IAN <br /> Generator's Phone; 209 305-0170 <br /> r >. <br /> 6.Transporter 1CompanyName U. ,EPAIDNum e€ <br /> i <br /> WORLD OIL.F;:#�Vit�Q�lPNfl;�d3'l�l.SERVICES GAD 0 2 8 2'7 7 t) 3 Ci <br /> 7,Transporter 2 Company Name U.S,EPA ID Number <br /> 8_Designated Facility Name and SlteAddrass U.S.EPA ID Number <br /> DEIvIENNO/KERWON <br /> 20W N.ALAMECIASTREC-f <br /> r >' 0At72 2. OAT1;800J.3352— <br /> XMI1ON <br /> acli sPhone: r <br /> F r lyl � <br /> 9b.U.S.DOT Descrtplion(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total. 12.Unit 13.waste Codes <br /> 9a. No Type quantity INUVOL <br /> HM and Packing Group(]f any)) <br /> 0 INO N4CRA,IJ ARC}OU$MTE,LIQUID(€SRAM FLUID) <br /> .ruiG+xtwk'1r�}a1sVaefsettit-.e':w4�Nh7risetie*i'rrni5t{3ursatiir.,al�utraa4�!rs'��,Wn#fk:'�. <br /> 0 MLU <br /> t� <br /> Z 2. <br /> C `ft-1148 WASI E STREAM HAS BEEN(QUALIFIED <br /> FOR RECYCLINGrfREATMENT AT THE <br /> 3. LlrC <br /> SF <br /> CYCLING FACILITY IN COMYTON,CALIFORNIA, <br /> THIS FACIUTY HAS THE NECESSARY <br /> PERMITS <br /> EVE YOUR WASTE STREAM AS QUAL F <br /> [SEED TO <br /> 4.. OUR EPA NUMBERTS <br /> ............... <br /> tr��aRiRY�IrY41�xt�=�1r,�syu� <br /> rMM.rql'1:1#i�F�fr�..r':YI�ShY+.Y4iN'i41'tYH,tilsk'.?� <br /> ut ' <br /> 14.Spec]al Handling Instructions andAddldona]Information ! <br /> EME;€ ENOY CON1:ACi:t.HI-MTR�t, -'1-800-424-9SCO WOES TERMINAL: €'f;cJl(1.�€fi 9131:�3�0�7 BRAK FLUID� <br /> r <br /> APPROPRIM PPE E'QUiPMEN-C <br /> 15. GEN(:RATOR'SfOFFEROVS CEeRTIFICATiON: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,arra are classified,packaged, <br /> marked and Iabeledfplacarded,and are in sit respects In proper condition fortransport according to applicable Inlemationaland national governmental regulations.if export shipment arM I am the Primary <br /> Exporter,t cerfity that the contents of Ods constgnment conform to the terms of the attached EPAAcknovrledgmenl or consent. <br /> cr; <br /> I certify that the waste mtnimizatkm statement]denlf3led in 40 CFR 28227(a)(it I am a large quanfily generator)dr(b)(if lAm.a small quantity generator)is true, <br /> oa 10paroE s PnnfedlFyped Nam 'Signature <br /> GeneratMaw Day Year n <br /> �''" <br /> F <br /> 18.international Shipments El Import to Us, Export Irom t),S. Portal entrylexil: <br /> Transporter signature(for exports onl# Data leaving U,S.: <br /> Qi <br /> W- 17.Transporter AcknovrledgntentofRoceiplofMaterials <br /> Month bay Year. <br /> TraTporter l PrinieditJrped Nemo , <br /> a. <br /> 4 <br /> Month Day Year <br /> Transporter 2 Printed/typed Nome <br /> 51gna Irtd <br /> IS,Discrepancy <br /> lea.Discrepancy Indication Space ❑ Quantity 0Type ❑Residue ❑Partial fteleetien ❑Fui1 Ra cuun <br /> Manifest Reference Number: <br /> lab,Alternate Facility(Or Generator) U.S.EPAID Number <br /> J <br /> CS ' <br /> LL. Facifily's Phone: Month Day Year <br /> lee,SlgnalureofAltemsleFaclllly(or Generator) <br /> i <br /> 19.Hazardous waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. . <br /> 3 4, <br /> 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in]tam 198 Mon li pay Year <br /> Prfntedffype Name f Signature <br /> G�Nf<RR <br /> EPA Farm 8700-22(Rev.3.05) Previous edltlons are obsolete. DESIGNATED FACILITY TO ATO <br />