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• i <br /> i •. 1 <br /> I <br /> Please print or .(Form designed for use at elite(12-pitch)typewriter.) Form Approved.OMB No.2050 0039 j <br /> UNIFORM HAZARDOUS 1.Gemerabr ID Number 2.Page 1 Enm*e q Response Pomo 4.Manifest Tracking Number <br /> WASTE MANIFESTrpnqAjr006228823.,_, FL E <br /> erator's Name and Mailing Address At t n:Car 1 o s M o s q u e d a Generator's Site Address(if different Dian mailing address) <br /> Pep Boys#711 <br /> •2099521222 4987LWes.t Ln <br /> Generator's Phone; Stacktrin-i M 51521A <br /> ansportef t Cor Wry Mme U.S.EPA to Number <br /> 7.Transporter 2 Company Name U.S.EPA Ib umber <br /> f <br /> 8. esignated Fa Oty erne and Sfie Address U.S.EPA t0 Number <br /> •.,•Ster".icycle,.:Inc. <br /> 2670 Executive Drive ; <br /> Indianapolis,—IN . 46241 <br /> Fa aT 'sPhoce: N 0 0110 7- -- <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, to.containers it.Total 12.Unit <br /> HM and Paddng Group(it any)) No. Type Ouantity WIMil. 13•Waste Codes <br /> X ! 'UNI 993, .Was te..Flammable•=1 iquids, n.o.s. 001. CF 00009 P - •D001;... 214, <br /> 0 (Acetone, Alcohols), 3, PG II, ERG-128 <br /> its <br /> "•X Waste,Aerosols,.. [flammable, (each not 001 CF - 00025. • P. D00 1 2.14. , <br /> exceeding 1 L capacity)], 2. 1, ERG-126 <br /> X 3,.UN1.956, Compressed gas, n.n.s. (Freon, Carbon 001 CF 00020 P 14 <br /> Dioxide), 2.2,. ERG-•126 <br /> 4. <br /> 14.Special Handling inshsclionsand AddillonalInformation 1.001PEP(Flammable Liquids) 2.002PEP,(Aerosols,••.Flammable) • 3. <br /> .:.018PEF;.('Non...FLataaabl e,.-.Gases) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedare)hat the contents of this consignment are hilly and accurately described above by the proper shipping name,and are dassi K packaged, <br /> marked and labol drptacardod,and are In e0 respects In proper conifft for transport according to applicable international and national governmental regulations.U export 94ment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Aclm ledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if 1 am a large quantity generator)or(b)(91 am a small quantity generator)is live. <br /> narato e s Prin-WiTyped Nwa Signaure Monthay ear <br /> Ad P41 PRI 316,Intemlibrial Shipments <br /> QImport to U.S. ❑Export from U.S. Port of en <br /> -- Trans _ers. .atunafor 1: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> aTransporter i Feinteciffyped Name nor ra - on ay Year <br /> yDaf.ford••Mckenzie.,,. <br /> z� tram Pdnted/f Name ,gnaturemonth My Year <br /> 6 r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ®Quantity El Type ❑Residue Q Partial Rejection Fail Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U,S,EPA ID Number <br /> v <br /> LL Facfii a Phone: <br /> w 18c.Signature of Alternate facility(or Generator) Month Day near <br /> Q <br /> Z <br /> y19.Hazardous Waste Repot Management Method Codes(La.,codes for hazardous waste treatment,disposal,and reci ciiog systems) <br /> W 1. 2, T. <br /> 4. <br /> 20.Designated Facility Owner or operator Cerlificatlot of receipt of hazardous materials covered by the manifest except as noted fn Item 1 <br /> PrintedR Name ng lure M tln Day Year <br /> EPA Form 870022(Rev.3.05)Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />