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Farm Approved,OMB No.2050.0039 <br /> Please print or type. 4.Manliest Traeking Number <br /> i Generator ID Number 2.Page i 4f 3.Emergency Response Phone S <br /> UNIFORM HAZARpOUS, 02038, _4 J <br /> WASTE MANIFEST-. C A10 0 019 4 30 T r i 0)424.e QO <br /> t. <br /> 5.Generator's Name and Madiirg Address. Generators Site Address(it different than mailing address) <br /> PEP BOYS 10562 <br /> 201 F ORCHARD STREEf �� N3 t5�D�7 1401��7U�H OHERC�KEF 1 ANE <br /> H MflNTON I C�t�l 959 flji <br /> GenaratarsPhone: 0 "411 U.S_EPA ID Number-8. <br /> umber8.Transporter 1 Company Name <br /> WORLD 11,ENVIRONMENTAL SERVICES C A[3 0 29 2 7 70 3 6 <br /> X7 <br /> U.S.EPA fl)Number I' <br /> 7,Transporter 2 Company Name <br /> U-5.EPA ID Number <br /> B.Designated Facility Name and Site Address _ <br /> WORLD Oth.RECYCLING <br /> 2000 N,ALAMEDASTREET• <br /> COMPTON CA 90222 CA T Ok 8 O 01 3 3 5 2 <br /> Facility's Phone: (11 O)s37-71 <br /> - e <br /> 9a. gb•U.S.DOT Description{Including propel Shipping Name,Hazard Class,@ 10.Containers 1t.Total 12.Number, Unit 19.Waste Codes <br /> HM and Packing Group tit any)) No. Type quantity WLNoI. <br /> a 1 NON-RORA HAZARDOUS WA$TF,LIQUi (BOAKE FLUID) 22� <br /> �- I)M C <br /> W <br /> 2.LU <br /> J t�iA�1FIED <br /> S 11 L! •t'iFS.�4�.v t L'.r <br /> FOS BECYGLtI�C��Ff;EE1TBAEVVT AT THE L <br /> OBLD OIL <br /> s. <br /> Fir-CYCLING FACILITY IN CON1C'TOR C t <br /> 1THIS FACILITY <br /> 3v-CF Y U WASTE STREAM AS QUAL FLED 1 O <br /> 352 ' <br /> 4, <br /> 14.Special Handling InsWctions and Additional Information <br /> EMERGENCY GONTAC :CHENITREC �,Q� `� ` [fit WOE,$. TFFRMINAL1 CERES CS NAlaRG#9Bi:.171*PI'OFILE 0 9131-15 <br /> . <br /> 452E114 TiRAE41 FLUID.,* *APPI OPI IATe PPE EQUIPMENT , � � - � <br /> 15. G@NERATOR'SfOFFEROR'S CERTIFICATION: f hereby declare that the contents of this consignment are fully and accurately described above by the propershipping name,and ora classlged,packaged, <br /> marked and labetedlpiaearded,and am in all respects in proper condition for transport according to applicable Intemallonal and national govemmental regula3lons.If export shipment and['am the Primary. <br /> Exporter,I certify Ihat the contents of this consignment conform 10 ft terms of the attached EPAAcknrnvledgmant of Consent. <br /> I certify that the waste minimization statement Identified in 40 GFR 262,27(a)(If I am a large quantilygenerator)or(b)(E am a small quanf4generator)is true. Month ' Day Year <br /> Generaluesiolferor's PdnlediTyped Name Stgnaturg , <br /> r 16.International Shipments LJ <br /> import to U.S. ❑Export tram, Port of entrylexit: <br /> Transpwler signature(tor exports only): pate leaving U.S <br /> qt� 17,Transpoft Acknowledgment of Raoeipi of Materiels Month Day :: Year <br /> Transporter i�Printedlfyped Nae Signature att <br /> k 10-7.1 <br /> a � A L1 vl�, <br /> � Manu, Day Yaar <br /> 2a Transporisr2PrinledlTyfedName Signature <br /> oG ' <br /> F . <br /> 18.Discrepancy <br /> I 8a.Discrepancy Indication Space El quantity L1Type ❑Residue ElPartial Rejection ❑Futl Rejection <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> J . <br /> U <br /> Facility's Phone: Month Day Year <br /> W 187Signature of Alternate Facility(ar Generator) <br /> 19. zardous Waste Report Management Method Codes{1.e.,codes for hazardous waste treatment,disp45al,and recycling systems) . <br /> p 1 IPA 2. i <br /> 3, 4. <br /> 2 .Designated Facility Owner or Operator:Certification of receipt of hazardous maferlals covered by the manliest except as noted In Item 1 Ba Month Day Year <br /> Printedlfyped Nan3e' Signature � <br /> DESIGNATED sb CIL I7 O GE <br /> EPA Farm 8700-22(Rev,1247) Previous editions are obsolete, <IE AT R <br />