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qT <br /> Wf <br /> Please print or ,type. (Form designed for use on elite (12-pitch) typewdlec) Form Approved. OMB. No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Genemtorlo Number 2. Paget of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST CAL000405595 g 844-3'34-2408 015895892 Jai K <br /> 5. Generators.Name and Mailing Address Generators Site Address it(different than mailing address) <br /> UARK UNIFORM AND C %aPEER APPAREL LLC <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 WEST INDUSTRIAL SERVICES0:41000177627 <br /> 7. Transpoder2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> '.{C5"="EM <br /> OLD k1VAST E RO•���GEMENT INC CAT0000401 17 <br /> KETfLEMAN, CA 93239 <br /> Facility's Phone: 800222-2964 <br /> go, 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 Quanfity Wt.Nol. <br /> 1. <br /> NON RCRA HAZARDOUS WASTE, SOLID 9 CF11 'r *211491_ 1 <br /> 4. <br /> ( <br /> 14. Special Handling Instructions and Additional Information <br /> PROFI LE O CA60802 <br /> 15. GENERATOR'SfOFFEROWSCERTIFICATION: I hereby declare thalthe contents of this cdnsignmentarefully and accurately descdhed above by the propershipping name, and are classified, packaged, I, <br /> marked and labeledlplacmded, and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations. If export shipment and l am the Primary <br /> Exporter, I codify That the contents of this consignment canker to the terms of the attached EPAAcknowledgamm of Consent <br /> I cardWhat the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator) or(h) (ifI am a small quantity generator) is true. <br /> Genprarsl0fferors Pdnted/Typed Name_ SlgnaWre Month Day Year I <br /> Ufa Z3 16 <br /> -.r 16. International Shipments <br /> F— ❑ Import to U.S, ❑ Export from U.S. Port of entry/exit <br /> z <br /> Transporter signature (for expodsonly): Date leaving U.S.: <br /> W 17.TmnspoderAcknowledgmenlofReceiptofMate0als <br /> T port l Prldadfryped Na�' Signa Month Day Year <br /> N � 'v 123 1 lob <br /> a Trampoder 2 PrintedFlyped Name Signature Month Day ear <br /> K <br /> F <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 /> U <br /> a Faclllty's Phone: ' <br /> C3 Ise. Signature ofAltemate Facility (or Generator) Month Uay Year <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes le., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 1. / 2. 3. 4. <br /> 20. Designated Facility Omneror Operator. Certification of receiplaf hazardous materials covered by the manifest exceptas acted In Item l8a <br /> Printedfyped Name SignatureMon Day Year <br /> // <br /> EPA Form 8700-22 (Rev. 3-MrPrlbilous editions are obsolete. DESIGNATED FAC61..ITV TO [DESTINATION STATE (IF REQUIRED1 <br />