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1 Form Approy0r3.OMB t46.2050=0035 <br /> please print of lYpo: K. <br /> 1,General6r lD t3umbat" 2 Page t of 3.Emergency Rimpornse Phone 4.Manifest Tra4king Number <br /> ONIFOR 1.NAXARDOUS : (�0[! -424-93013 'i�► "` J"JK <br /> `.._WASTE MANIFEST C A L O 003.9 4�0 1 <br /> 5:Generators Name and Maili Address Generaess) <br /> Generator's Site Address(if different€pari mailing addr <br /> PEP BOYS-00567 <br /> CHROKEE LANE <br /> HAMMIN ON Mdl t�37 OA 9524U <br /> 209 365-0176 <br /> Lf�131' <br /> Generators Phone: EPAt0 Number <br /> 6.Transporter 1 Company NameRI] <br /> QRLD COIL ENVIRONMENTAL SF-RVICEs G .�0���7 7 s�;�� <br /> U.S.EPA ID Number <br /> 7.Twasportef 2 Company Nania <br /> WORLDWIDE RECOVERY SY5fEM INC. C A I�O A 0 ! 7 ���� <br /> . <br /> 8.Designated Facilil Name end Slte Address' US.EPA i Number . <br /> yy D <br /> YES MAGEMENT,INC. <br /> 6500 US HIGi-WAY 95 <br /> YUMA A7 95365 A Z R 0 0 O 5 2 114 a I <br /> Facifity's Phone: (928)344-9826 <br /> 9b.US,DOT Dascrip9on[including l roper Shipping Name,Hazard Class,0 Number, W.Containers 11,Total 12.Unit 13,Waste Codes <br /> 9a. No. Type Quantity Wt.No1, <br /> HM and Packing Group(if any)) <br /> INON-RCRA HAZARDOUS WASTE,-SOLID(BRAKV LATHE SHAVINGS) lei <br /> l$i <br /> .}- <br /> LU <br /> 2, <br /> LU <br /> 3 ' <br /> 4. . <br /> Addigonal In(wmalian r•t'?:': , ''' <br /> 14:5pecla3_Han0lingfnslructionsand :' � ..'. �•` •.'`;"'�`'``'`'�;�,' <br /> E i R0E l0Y"Ct r TA[; :t;f IEt T REC :1-800-424-9300 WOES T ERMINAL:-CERES CS �PROFILE 0 9BI:161623NR "I�E�'344" .::ti;,; <br /> 1 1%AGtE LAT SHAVINGS �� *APPROPRIATE E PPE EQUIPMENT <br /> � <br /> 15,. GE NERATOR'S1oFFVROR'S CERTIFICATION; I hereby declare that the contents of this cumignnrent are fully and accurately described above by the proper shipping.name,and are class€lied,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to appliObie Intema6onaland national govommental regulallons,if expartshipment and I am the Prima <br /> ry <br /> ExpadorKt certify that the eantents of ibis consignment conform to the terms of the attached EPAAcknowiedgment of consent 4 ever for rs true. <br /> I certify that the waste mWirolzallon statement Identified in 40 CFR 262.27(a)[if I am a large quanllty generator)or[b)�]ff efrra'small uan8ty 9- 0 ) Day" Year <br /> Ge"eralorsfOtfer s 'nledffyped Name <br /> 16;:httern@tional Shipments Import to U.S. ❑Exportyorwrj.S. Part of enirylextt: <br /> F5 - fDale leaying U.S:: <br /> Transporter signature(for exports only): <br /> 17 Transporter Acknowledgment of Receipl of Maler[ats I i F ti r <br /> Transport niedffyped. ame <br /> Signature / f Meath Day' Year <br /> a. S[ "_{4 ' V y Month " Day. Year <br /> nledlf ed a e I } Slgnau a l-r <br /> o <br /> 18•Discrepancy <br /> 18a.D€screpanCy Igdfca' n Space ((� - Residue ❑Partial Ro]ectton ❑Full fiejection <br /> l�t Quauiity ype <br /> _. ._ •.: '.• .,, .-.- �._. .. , . l 'S,. ��J" _ - <br /> '` Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b.Allemate Facility(o€Generator) <br /> V <br /> U- Facility's Phone:. Month Day Year <br /> w 18c.-Slgnafure of Alternate Facility(or Generalor) <br /> Q ' <br /> 19.Hazardous Waste Report Management Method Codes[f.a.,codes for hazardous waste treatment,dispnsat,and recycling systems) T <br /> 3, <br /> [1 1- <br /> " <br /> 2R.Designated Facility Gwrier or Operator;cartiRealion of receipt of hazardous mater€als covered by the manifest except as ncted In Item lea <br /> SignalurriMonth Day Year <br /> Prinledffyped Name . <br /> DESIGNATED 1=AC lLIT'(Tf}0 ENERA7 OR <br /> EPA Form 87.00-22(Rev.12.17) Previous editions are obsolete, " <br />