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Form Approved;OMB No 205f)iTQ3 J <br /> Pte,so print or type. <br /> 2.Pagel of 3.Emer enc Response Phone 4,Manifest Tracking Number_ ' ' <br /> UNIFOIiI HAZARDOU�1, rator ID Number 9 g. Y p <br /> WASTE MANIFEST #L 0 0 �07 <br /> -1 (80 0)424 9300 02 .. JJ <br /> 5.Generators Name and MaitingAddress Genera€ors SileAddress(If different then mailing address) • - <br /> PEP BOYS 60562 : <br /> 20 F'ORCHARD STREET 01303-1 1401 SOUTH CHEROKEE LANE, <br /> HAMMONTION <br /> 209 36&01.7 I_�DI CA 52401 <br /> Generator's Phone: —77—US,EPA ID Number <br /> 6.Transporter 1 Company,Name ' <br /> MORLP OIL.I*NVIRONIVIENTAL SERVICES C A.D 0 2 8 2 7 7 0 3 6. <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name' t <br /> WORLDWIM RECOVERY SYSTEM INC. C A R 0 0 01.7 5 4 2 2 <br /> 8.Designated Facility Name and Site Address M.EPA ID Number <br /> YES MMAGEMENT, INC. <br /> 6WO US HIGHWAY 95 <br /> Y# NIA P2 85 6 AZR 00521/46 <br /> FacilHy's Phone:- (929 344-9828 <br /> 9b.U.S.DOT Deseriplion(Including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.WasEe Codes <br /> ga• QUIWt.Nol. <br /> HM and Packing Group(if any)) No: Type <br /> lwNprm HAZARDOUS WASTE,SOLID(PAPER FILTERS) 352 <br /> DM loo P <br /> LLI <br /> I <br /> 3 f <br /> 4. <br /> 14.-Special HandlinglnslruatlonsandAddlli0na11nlofmation r C�jr,(.0 Q_ <br /> EMERGENOY CONTACT;CHEI�TRE0 1-800.424-€9300 DOES TERMINAL:CERES.CS N 9 7 '�pltf FILE#90�; <br /> 161623NRS-PEP344 PAPER FILTERS APPROPRIATE PPE EQUIPMENT <br /> 16, GENERATOWSIQFFEROR'S CERTIFICATION; I hereby declare that the contends of this consignment ace fully and accurately described above by gra proper shipclassified,packaged. <br /> name,and are clapackaged, <br /> marked and labeled/placarded,and are In all respects In proper cont€€tan for Transport according is applicable Inlernationatand nations!governmental reg-ui�a6ons,.lt expori'shipment and i am the Primary <br /> Exporter,I codify that the contents of[his consignment conform to the terms of thea€cached EPAAcknowtedgmon!of Gonsenl. dt es or I trua, <br /> I certify that tine waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(fl am a small quu <br /> General orsfOfferoesPriote"pedName Sign urs - /' Month _ Oay Year <br /> a 16.Internaltonat shipments El Impact to U.S. ❑Fxpod from U.S. Port of entrylexil; <br /> ? Transporter signalui6(for exports only); <br /> D leaving U.S.: <br /> 0� 17,TransporterAcknotivtedgmentof Receipt of Materials <br /> Uj TransItto Prinlgdlry d Nato <br /> Signature Month Day: Year <br /> t2 <br /> t` <br /> pQi Month Day Year <br /> Transporter 2 PAnledffyped Nt. Signature �.•- `� r �t 7 <br /> . <br /> 18a.D€screpanuy kdlcation Space..•_ Quanliiy El Ty' ❑Residue ❑Partial ReJeclfo€t ' Full Rejection <br /> ' Manifest Refe€ence Number <br /> 18b.Allems(e.acidly(or Generator) U.S.EPA lb Numbet <br /> ►moi kcdiy's Phase;; Month Day Year <br /> I!! ec,0001116 OfAitsmale F_adIlly(or Generator) <br /> 19 Ha7afdous Waste R;pA Managuhiegt Method Codes(l,e.,codes for.hazardous waslo Irealment,dispasal;and *mg systems) " <br /> uJ 1 2,. L. 3 4' <br /> $O,Qesignated Facility •.vnar or Operator:Cerliticahpn v[recerp€b[ice rdolis materials c6er2d by lha martrlest except as Wrist in item,l8a c <br /> PririledfTypod Name (J 4 Signature r1 a Mo/nth Jp/jayr3: (rYear//} <br /> (/` `l F7 {/ r 't�5 t i i - 5 + + - - `,...C' •� - -` f 1�I S ! - f 5 <br /> l If�5 .l :ii 7�' ->!ff � � Y x�bj 7r� 1 L •t - -' '�.'.'. , <br /> 7 Previous edihonsare opsbl e, �F ski&sup ,if s' l [�E�f��1,4�X13 F�CILI�'TO <br /> A oiin 870a 22{ ev,121 nk <br /> I S <br /> I r <br />