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a - Porro Approved,OMB No,2050-0039 . <br /> Please p'rinl of type... 4.Man. TrackingNumber <br /> UNiFORNI HAZAR©ous" I.Genorato€III Number 2 P ge l of" 3 Emergengy Response Phone <br /> WASTE MANIFEST <br /> C A#_0 0 010 4.3 0 7 (BCD) 2438[}0 , <br /> 6 <br /> 5.Generator's Name and'Mailing Address Generalo�s Site Address('rf digerenl Ihari mailing address} x i <br /> PEP BOYS#0582 <br /> 2011E ORCHARD STREET 1401-SOUTH Ct��R KE5 LAVE <br /> HAMMbi�TC I 4 3 08087 LC3i71 . CA 95240. <br /> Generators Phone: <br /> 209.'385-0175 U.S.EPA ID Number <br /> 6.TransposEert company"Name" 2 8277036' <br /> WORLD OIL ENVIE�diVMENTAL SE:RVECES U.S.EPA ID,Number <br /> 7:Tran-sporte€2 Company Name x <br /> U.S.EPAID Number <br /> 8,Designated Facility Name and Site Address <br /> WORLD OIL RECYCLING <br /> 2000 N.ALAMEDA STREET O A T Q B f717� 3��2 <br /> C+;?MPTON CA 90222 <br /> Facility's Phone:. - <br /> 9b-U.S.DoT Description{including Proper Stripping Name,Hazard Class,16 Number, 10,Containers 11.Total 12.Unit 13.Waste Codes.. <br /> and Packing Group(if any}) No. TYPa <br /> Quantity WI,Nol. <br /> HM <br /> "NON-RCRA HAMRD©US WASTE,LIQUID(BRAKE,FLUID) <br /> a - � 1fl1iF7rst;-?;.>;�lS1YtE;SCk.lr3�irla�IfwS�,lAiLKl:i;le�J$}:I.tlti`$"k71F'F;• i;s[+c.'kt„J,rilia5i+'�. - ❑,M <br /> a7 S•: <br /> LU 2'" THIS WAST5 STREAM HAS SECNI'OUALIFIED <br /> FOR F3E CYCLINCill AL T t41E1�i7-AT THC . <br /> DeAdElgt•10/ICERDCIOf I DOA r/'101 iL0 OIL <br /> FACILITY im ComrrON,CALIFORNIA: R <br /> PHIS FACILITY HAS THE NECESSARY PFRMI•f S TO u <br /> RECEIVE YOUR WASTE STREAM AS QUALIFED, <br /> ('slJR EP!r.IJUMCER IS CAT <br /> eH:nrgirr?:kN►!>.*,r'Pn':s.^t'?%C't:.• Eng'r'';i',5?1�`,7;,ry9,M1'rfb7'e`itix''7At4i'uil'rf{S+�fti�lVS�'j' <br /> t 14.Special Handling Instructions and Addill olral lafo€madon <br /> l <br /> 'FMERGENGY CONTACT:'O'H wh�TRE C:1-E3D0.42"300 WOES TE^RMI61E�11:Gk�dE 5 5 .NRF#7G E�� . 7 *:PROFILE€ St�1.. <br /> 452014 DRAKE FLt1Ee* x AppEiG�PRE,4TE PPE EQUIPMENT <br /> are <br /> •1&., GENERATOR'S/OFFEROR'S CERTIFICATION:i hereby declare Thal the contents of this consignmenllcaltle tnlemationa and naGorire folly add accurately es lgovemmental Feg IatloAs,e�above'by the 1lfRexpar(hipm;ing name, n nd Istn the Prirna€y <br /> maEked and IaliEteiilplacarded,and are In all respects in proper condiliontor.transporl a=rding to app s' <br /> Expodgr,I ceilif-lhal the contents of this consignment conform la the terms of the attached RI'AAcknowledgmeril of Corisenl : <br /> ('certify that Ihe-wasio minimization statement Identified In 40 CFR 262.27(a)(If I am a large quantity"generalo€)or(b}{if I am a small gisantity generator)Is hue, Month Day - Year <br /> Slgneture' . <br /> Generatorslofferor's PdnlodlFyped,Name e <br /> 16.Internationalmeals Export€rom U.S. Port of entry/exil: <br /> ❑Import to U.S. Date leaving U,S,: <br /> Transporter signature(for exporis only): <br /> oG 17,Transporter Acknowledgment of Receipt of Materials Mr»tlh Pay. Yeaf <br /> Trans e 1 PrintedfTyped Name Signature _ ' / <br /> r �l 2 I <br /> L" /� tl`t Y Month' Day Year <br /> Tfarisporles2�Printed{iyged Name Signature <br /> 18:biscrepancy :: nn <br /> L J Raaidoe 0 Full Re eolion, <br /> 18a.blic'r`epanoy indication Space quantity ❑Type ❑Partial Rejection <br /> ± Manifest keference Number: ' <br /> �'• U.S.EPAIDNurrrher ' <br /> It= <br /> 1W Alternate Facility(or Generator) <br /> FacilitysPhono: Month Day Year <br /> E-3 led,Signature of Alternate Facifily(or Generator) <br /> 1g.Hgzardous Waste ReportManagement Method Codes(I.e„codes far hazardous waste treatment,disposal;and"recyciing systems); 4- <br /> 0 1• 2; 3 <br /> ated�ill Owner or operator-certification of fecslpl of hazardous matedais covered by the manifest except as tided in Ifem t8a• <br /> 20:IIesign ly Siynalure, , " Month pay year <br /> PflnledfTyped NametAo 1r <br /> �J <br /> �l "` DESiGNATED'FACI�IT TOO 14ERATO1� <br /> EhA Form 8 -22(ReV.12-17) Previous editions are obsolete. <br />