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Fofm Approved.OMB No,2050 0039 <br /> Please print d type: <br /> UNIFORM HAZARDOUS 1 Generator 1D Number 2,rage 1 of 3=Emergency Response Phone 4,Manifest Tracking Nyum�er <br /> tNASjE MANIFEST CAL 0 0 0 19 4 �3 0 7 � {500)'��4.93t�0 �� �+ �� <br /> 5.Genera;ors Name and Mailingkddress Generator's Site Address(if different than mailing address) <br /> PEP-BOYS,#0562 . <br /> 2bi E OR014ARD STREET <br /> HAltiflMONTON �ta37 1401.SOUTH CHEROKEE LANE <br /> X09366-0175LODI CA 96240 jl <br /> Generator s phone: 209 €D Number <br /> S.Transporter 1 CDmPany Nome C'A D 0 2 8 2 7 7 0 3 0, <br /> WORLD OIL ENVIRONMENTAL SERVICES <br /> U.S.EPA ID Number <br /> 7-T€on_sponer 2 Company Name <br /> �ICC RECOVERY SYSTEM INC,WOR L; CAR 0 0 017 5 4 2 2 <br /> U,S.EPA ID Number <br /> a.Designated FaciTty Name and Sile Address <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 A Z R O.0 0 21 i 4 6 <br /> Fact# a phone: 8 AAA9A <br /> gb=U.S.60T Description(Including Proper Shipping Name,Hazard Class,ID Number. f0.Containers 1fT11 13.Waste Codes <br /> 9a. and Packing Group tlf any)) No. Type QHM <br /> 1.016�-RORA Iii ODOUS WASTE,SOLID(PAPER FILTERS) l352 <br /> C7 0 <br /> i <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14-Special Handling tnsln€cGDnsandAddlional 3nformatian <br /> i <br /> EMERGENCY CONTACT:CHEMTREC 1.13015'424-9300 WOES TERM*L:OERES -NAERO#9BI:�71 *.P#�OFII F#9�� <br /> 161623NRS-PEP344 PAPER FILTERS * *APPROORIATE PPE EQUIPMENT.. <br /> 15. GENEItATOR'SfOFFEttOR'S CERTIFICATION: f hereby declare that the contents of this consignment are fully end aecuralely described above by the proper shipping Hama,andare classified,packaged, <br /> marked and laboledlpiacarded,and are in all respects in proper condition for transport according to applicable Internationalaitd national governmental regulations,if export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minirnlzation statement identified in 40 CFR 282.27(a){if t am a targe quantity generator)or(Is)(lff am a small quantity generator)Is We. Month. Day Year <br /> Ga eraters{Offeroes P[intediTyped Name Sign tune07 <br /> - <br /> -j is.€ntemational Shipments _ ❑Import to U,S. ❑Expert from U.S. Part of entrylexll:. <br /> Transporter signature(for experts-only): Rate leaving U.S.: <br /> r <br /> w 17,TramporterAcknowladgmentofRecelplBfMatedAs ! <br /> 1 Signatu€ __ Month Day Year <br /> Trans I War 1 PrintedfTyped Name <br /> a / - Month Day Year <br /> Z, fro port. 2 Prinledlf ped Name JJ/ 51g alum•. / _ 1 l <br /> . <br /> iB.Dlscrepancyf '''� � . <br /> 18a.Di c e r�nc IndicaGan Space ~❑ ❑Res'sdue ❑Partial Refection Full Rejection <br /> P Y ❑ Quantity Typo <br /> 1' Manifest Reference Number: <br /> ' U,S.EPA ID hfumber <br /> F 18b,Alternate Facility(or Generator) <br /> w Facility's Phone: Month pay . Year- <br /> w 180,Signature olAltemate Facihty(or Generator) f <br /> Q <br /> Z <br /> 19.Hazardous Waste Repoit Management Method Codes(I,e„codes for hazardous waste€reatmeni;disposal,and recycling systems) <br /> Q 1 <br /> � � fI <br /> 20.Designated Facility Owner or Operator:Cedincation of receipt of hazardous materials covered by rho manifest except as nd in Item 18a Month Day Yeas <br /> PrintedRyPed Nae f Signature <br /> ESIGNAT ED FACILITY TO GENERATOR <br /> EPA Form 8700-22(1Tev,12-17) Previous edilions are obsotote, i <br />