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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) . Form Approved, OMB No, 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4, Manifest TrackingNumber ry WASTE MANIFEST CALOOD405596 844-334-24k33 015895893 qJJ S. Generator's Name and Mailing Address Generators Site Address (9 different than mailing address) ARAfvARK LINIFORM AND CAREER APPAREL LLC 797 LONGE ST ST t CKTON, CA 95205 Generators Phone:209-234-9105 8. Transporter 1 Company Name U.S. EPA ID Number PHI LI P WEST I NDUSTRIAL SER V I CES CAR000177527 7. Transporter Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number CHEMICAL WASTE €1AANAGEf�7iE[VT IhJC CAT000045117 35251 CLD SKYLINE ROAD VETTLEMAN, CA, 93239 Facility's Phone: 800-222-29004 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (ifany)) No. Type Quantity Wt [Vol. '.. i. Of NON RC:RA HAZARDOUS WASTE, SOLID 1 ' Gari 610 Y ma1491 I� z 2, p j p k 3. [ 4. 14. Special Handling Instructions and Additional Information '.. PROFILE # CA608852 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby ddeclare that the contents of this consignment are fully and accurately described above by the propershipping name, and are derailed, 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 I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknovAedgment of Consent. I codify that the waste minimization statement identified in 40 CFR 26227(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is We. Genera rs(Offerooes PPanted[Typed Name Signature Month Day Year El I i5 130114 16. International Shipments i— 11 import to U.S. Ll Expert from U.S. Port of entryledt: Transporter signature (for exports only): Date leaving U.S.: 0= 17. TranspoderAcknoWedgment of Receipt of Materials Tra porter 1 Pririted/ryped Nam - Signet a Month Day Year a 1661t? a Transporter 2 Priniariftyped Name Si to Month Day Year K r-- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Fuil Rejection Manifest Reference Number: 1811c. Alternate Facility (or Generator) U.S. EPA ID Number J U rat. Facility's Phone: w 18c. Signature ofNtomate Facility (or Generator) Month Day Year B 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) - ® 1. 2. 3. 4. 20. Designated Facility OwnR or Operator: Certification of receipt of azardous materials covered by the manifest except as need in Item 1 a Printed/fyped Name Signature M Day Year EPA Form 8700-22 (Rev, 3-q Previous a itlons are obsole e. DESIGNATED FACILWOTO DESTINATION mm (gF REQUIRED)