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<br /> FormApproved,4M6 No,2050.0039
<br /> Please print or type,(Form designed fpr,use on elite(12-pitch)typewriter)
<br /> UNIFORM HAZARD US t-Ger 6WOf ID Number 2,Page 1 of 3:Emergency Response Phone hti Manifest Tracking Number 1 9 9t .
<br /> WASTE MANIFEST G'A 1.C1 0t 0 �,9 4 1(3 7 :( t'i )4'�R aJ_� P` .,i �' ���A.1JrD C!
<br /> 5.Generalists Name and Maiiidg Address Ganeratar's Site Address(II different than mailing address)
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<br /> PEP BOYS#0�(32
<br /> 'IL)I,E,ORCHARD-STREET
<br /> 1 F 6'3C Edd ( G, `l, 1401°x: UTH t.l••(E1~OKEE k.A,M9
<br /> Generators Phone: 7''s 365-017 1 CkCil (A
<br /> U.S.EPA ID Number
<br /> 6.Transporter 1 Gompany Name :.-
<br /> VVOrfl-D Cil! VEriF1 1 !° 4')T tl yl l d ;s O R D(5'2 8 2 7 7 036
<br /> 7,Transporter 2 Company Name ' U.S.EPA lD Number
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<br /> Ci43d�'i -r''ti�{�_rr-�IEf�: ��:F��> � � 7�._ �� -�•::
<br /> $ pear tlatadFacllity:Nafitaphdslleddrssss� : ..~lrs:ERA 'f�ur6efi-
<br /> 6,xM, LIZ iIIC11WI F 135
<br /> YUMA IV_ 86381, AZRr)006211-46
<br /> Facility's Phone;
<br /> 9b.U.S.DOT Description(Including Proper Shipping Name;Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13,Waste Codes
<br /> 9a, No 7YPe Quantity WLIVol.
<br /> HM end Packing Group(if any))
<br /> 1"P1r3f"d b;f� ')� V ',VP-aff,SOHD(PAPER P1U--'R-q)led
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<br /> 14.Spec-sal Handling Instructions and Additional Informailon « j`+, �lr
<br /> EtAt`"RQ-- 1-;Y CONTAO ,4,1•oErA I'SEC 1.'4C444_�.
<br /> .:..'� ./1."� At� rY JBv'f E�u°i_�ii„4 ?'4l iY.iiPA� '".�)`r' 4� '- 4
<br /> 15. GENERATOWSIGFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and,accurately described above by the proper shipping name,ard'are classitiad,packaged,
<br /> marked and labeled/placarded,and are in all respects in proper rendition for transport according to app€icable International and national govemnienlat regulations.][export shipment and I am the Primary
<br /> Exporter,I cortily that the contents of this consignment conform to the terms of the attached EPAAcknowledgmentaf Consent. '
<br /> I certify Ifial the waste minimization stalament Identified in 40 CFR 282.21(a)(KI am a large quantity generator)or(b)(II I amVmall quantity generator)Is true.
<br /> Month Day Year
<br /> GeneralerslOfleror's PrintedClyped Name
<br /> l! Signature
<br /> -�j 16,International Shipments ❑Ex ort from U.S. Port of enlrylexll;
<br /> F ❑lmpo€t to U.S. p
<br /> Transporter signature(forexports only): Dale leaving U.S,;
<br /> W 17.Twnspotteikknowledgment of Rec6ipl of Materials
<br /> Transpoder 1 Prinledflyped Na tne Signalure , J Month Day Year '
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<br /> s Mont Day year
<br /> Q Transporter 2 Printed/Typed Na
<br /> me SignatureWA-
<br /> F A•`rY1_.F K L.,
<br /> 18.Discrepancy f
<br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue' ❑partial Rejection ❑FullRe(eclton
<br /> Manifest Reference Number:
<br /> 18b.Alternate Facility(or Genarator) U.S.EPA fd Number
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<br /> FacititYs Pb'one Yea
<br /> 18c;;Sigo�lure,4).AtlPmate Paclfgty(ar C�engr�lork ,:'- '. �
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<br /> 19,Hazardous Waste Report.Management Method Codes(f e.,codes for hazardous waste ireaiment,disposal,and recycling systems)
<br /> � 1 4.
<br /> 20,Designated Facility Owner or Operator:Cedincallon of receipt of hazardous materials covered by the maniresl except as Rated in Item 18a 1 Month Day Year
<br /> Prinledfr Quo Name Signature CA
<br /> EPA Form 87,0022(Rev.3-05) pSevlouseditions are obsolete. DESIGNAICEl) A -L� TO GEEI AT®I STATE(IF REQUIRED)
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