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FF rvck � 5 4 � Please print or type. (Farm designed for use On elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 FFFFFFFFFFUNIFORM HAZARDOUS 1. Generator ID Number 2. Pae 1 of 3. Emergency Response Phone 4. Manliest Tracking Number WASTE MANIFEST CALg0Q�055—'� 84 34-248$ 015 95890 JJ 5. Generator's Name and Mailing Address Generatofs Site Address (if digerentthan mailing address) ARAMARK UNIFORM AND CAREER APPAREL LLC 7879 LONGE .57 STOCKTON , CA 95200 Generator's Phone:2$$"294FFFO r 05 U.SEPAID Number 6. Transporter 1 Company Name . PHILIP VVEST INDUSTRIAL SERVICES CAR000177527 U.S. EPA ID Number - 7. Transporter 2 Company Name 8. Designated Facility Name and sun Address INC . EPAID Number �fEMlr;>s,L WASTE MANAGEMENT' 1.10 CRT000840117 35251 OLD SKYLINE ROAD KETIFLEMIM41, CA 93239 Facilltivs Phone: 9a. 91c. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type Quantity wlivu. HM and Packing Group (if any)) I t a NONtNONRCRA HAZARDOUS VsjASTE, SOLID9 Chet —— I 3. f 4. d j 14. Special Handling Instructions andAdditionai informafion P ',. PROF! LE 0 CA608852. A *7 Pall 15. GENEL OOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are In all respects In proper condition for transport according to applicable international and national governmental regulations. If export shipment and l am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I cerit(y that the waste minimizatlon statement identified In 40 CFR 26227(a) (If l am a large quanily generator) or (b) (If l am a small quantity generator) is [me. Monti Day Yepr� pe erator'slOfier s Printedfryped N me I Signator f/ J 16. international Shipments ❑ Import to U.S. Export from U.S. Port of en aDate leaving U.S.: Transporter signature (for exports only): W 17. TramporterAcknowledgment of Receipt of Materials Da Year K Transpodelf Priatedilyped Name Signatur Monlpl y O - {b¢ E,, Month Day Year GTr sporier2 rinted(fyped Name Signature h 18. Discrepancy tea. Discrepancy Indication Space Ll Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U LL Facilil�/s Phone: Month Day Year W tac. Signature ofNternate Facility (or Generator) Q z a—i 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 4. 20.�\ tenatedFacility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In Item 16a Month Day Year Ponledfryped Name Signature