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Ixaii. ruinr nr h raw IFnrM dcislnnurd !ar use nn elite tl2-nitchl tvoewftr.) Form Approved. OUB No. 2050-0039 <br />EPA Form 6700.22 (Rev. 3.05)Previous editions are obsolete. iTRANSPORTER'S COPY <br />UNIFORM HAZARDOUS <br />�_.. <br />1. Generator ID Number ## <br />2. Page 1 of <br />3. Emergency Response Phone <br />'ct39.= <br />Numrber '} <br />4. Manifest Traciding1'z877 <br />1'z 8 7 JJ K <br />WASTE MANIFEST <br />f ti 1 i �$`�;rf : <br />i <br />f; °s <br />3J i i <br />5. Genwatoi` Name and Mailing Address • Generators Re Address (if different tan raging address) <br />> > <br />PEP BOYS 4710 <br />t <br />.T5 E. CHAR. WAY <br />ATP K CA 452&-t 200 -6W <br />Generator's <br />6, Transporter f Company Name U S. EPA ID NLmher <br />All,r „y ONINVVNTTAL <br />1.7tansparter 2 Company Name U.S. EPA lD Number <br />a. Uesigriatod Faci!iy Name and Site Address U.S. EPA ID Number <br />a� P'u1�.�..'.M'sl'rAL, <br />Fact' s Pho&.. V.t ANA. tv.A i''_i ti5 1" V-=Nt.S'90A,5 <br />ga. <br />9b. U.S. COT Desc*on (Including Proper Shipping Name, Hazard Class, ID Num* <br />10. Containers <br />11. Taal <br />12, Utdt <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Paclong Group (,f arty)) <br />Quantity <br />Wt.Alol. <br />O <br />zrry mazApm—pus vn%sa T gim <br />00 I <br />W <br />I <br />3. <br />1 <br />{ <br />r <br />4. <br />} <br />14. Special Hand'fng Instructions and Additoaal Information <br />ho; . T.TSEr AMR r"—A' g P# -Mi L aif, T iC97 i; VQ, UV AMT <br />15. GENERATOR'SIGFFEROR'S CERTIFICATION: 1 herrrby,declare thatthe contents of this consignment ars fully and accurately described above by the proper snipping rame, and are dassifed, packaged, <br />marked and'abeledlplacarded, and are'n all respects in propercondition for transport according to applicable international and national governmental regurations. if export shipment and I am the Primary <br />_xportsr, I cer fy that the contents of He ceneigm+ent cortionn to the terms of the attached e-PAAcknow'edgmenl of Consent <br />I certify that the waste rninimizat an statement identified In 40 CFR 262.27(a) (0 I am a large quantity generator) or (b) (if( am a small quantity generator) iS true. <br />Generstoes/OOeroes Printeorryped Name Signawre Mon;h Day Year <br />�T c - <br />-i6. <br />1— <br />rtamadonal Shipments ;11 <br />❑ Import to U.S. lJ Export from U.S. Port of entry/exit: -.. <br />Transporter sigmahrre (nor exports only): Date.eaving U.S.: <br />K <br />17.TranspwterAcluvwledgmerlofRace-ptof.Materials <br />w <br />S(gnahee/� Month Day Year <br />lzlz <br />Transporter 11P�Pnhtedlryped Nano <br />Transporter 2 PrntedfTyped Name Signature Month Day Year <br />F <br />1e. Discrepant' <br />18a. Ciscrepency Indtcalion Some Quantity O Type u Residue ❑ Par. at RejecFan ❑ Full Re ection <br />!Awffest Reference 4 jr.w: <br />F} <br />J_ <br />' . Aitemate Facility (of Generator) U.S. EPA ID Numberft. <br />V <br />IaL <br />Fldi"/S Picne: <br />12c Signatue &Xlemate Facfy (orGencraw) Month Jay Year <br />Qw <br />z <br />7 <br />19. ,iazardcus `h'aste ReportManagement fdeihod Codes (i.e., codes for tazardous was a ireagnent, disposal, and recycling.systems) <br />G <br />1 <br />l� <br />20. Dellgnated Facdiy Gw�r m Qpe . Certifkadon cf receipt of AalaMrx s mate''ela covered by Q+e mam':ast ex nded m .'em 18a <br />yp� Nems 7 S gra .Mc th. Day. <br />%_ . year <br />a <br />It <br />EPA Form 6700.22 (Rev. 3.05)Previous editions are obsolete. iTRANSPORTER'S COPY <br />