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Please print or type. (Form designed Jor use on elite (42-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> dJNIFORM HAZARBOUS 1:GeneratorlD Number 2. Pa ! of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST C,4g.0004,0559� 244-334`246+ 015 95891 JJ <br /> 5. Generalgrs Name and Mailing Address. Genemtors Site Address (if different than malling address) <br /> APMARK LINIFORM AND CAREER .APPAREL LLE <br /> 7679 LONGE ST <br /> STOCKTON, CA 95206 <br /> Generators Phone:209-234-0105 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> PHILIP t?'v'EST INDUSTRIAL SERVICES CARO Q0177627 <br /> 7, Transporter 2 Company Name U.S. EPA 1D Number <br /> 8. Deslgnated.Facllity Name and SiteAddress U.S. EPAID Number <br /> CHEMIC�.L Vv°I�STE MAN,AGEf�iEtV"i INC U.S. <br /> 35251 OLD SKYLINE ROAD <br /> KETTLEMAN, CA. 93239 <br /> Facility's Phone: 29L1+22MG 64 <br /> ga. 9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No, Type Quantity WtMoI. <br /> 0 1. NON RCRA HAZARDOUS WASTE , SOLID 1 CSA % � V ; � 491 <br /> � t <br /> 3. { <br /> I <br /> 14. Special Handling instructions and Additional Information <br /> PROFILE 0 CA6088.152 <br /> 15, GENERATORTIOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment am fully and accuratelydescribed above by the proper shipping name, and are classified, packaged, <br /> marked and Iabaledfplacarded, and are in all respects In proper condition for tmnspmt according to applicable International and national governmental regulators. if export shipment and I am the Primary <br /> Exporter, l certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I codify that the waste minimira(ion statement identified in 40 CFR 262,27(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) Is true. <br /> GimprIfsfOrferors Pdritedflyped Name Signator Month Day Year <br /> �A 16. International Shipments <br /> r - ❑ Import to U.S. ❑ Export from U.S. Port of entryfexlC <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> Do 17. TransporterAcknowledgment of Receipt of Materials <br /> K Tmnspode 1 Printed/Typed Name Signature Mo Day . Year <br /> 0 <br /> 37) <br /> Tmnsporter2 Printedr[yped Name ign re Month Day Year <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity []Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> ❑a- Facilityvs Phone: <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> Q <br /> y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ® 1. 2. 3. 4. <br /> F <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Printedflyped Name Signature Mott Day Year <br /> Nil . <br /> EPA Form 8700-22 (Rev. 3- 5) Previous editions are obsolete. UESIGNATEU FACILITY TO DESTINATION STATE (IF REQUIRED) <br />