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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, GeneratmlDNambef - 2. Pagetof 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAaL0094L�5595 �- - � 15 p 9 51 9 4 JJ K 5. Generators Name and Mailing Address Generators SlteAddress (it different than mailing address) AR,®,4VORK UNIFORM AND CAREER APPAREL LLC 7679 LONGE ST STOCKTON, CA 95200 Generators Phone:26P'234-01 Q5 6. Transporter 1 Company Name U.S. EPA ID Number PHILIP WEST INDUSTRIAL SERVICES CARD00 E 77521 7. Transporter2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPAID Number CHEMICAL WASTE MANAGEMENT INC CPT0000461 17 35251 OLD SKYLINE ROAD KETTLEIMN, CA 93239 Facility's Phone: c310I}-222-2'94$`1. 9a. gb. 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 litany)) No. Type Quantity WLA7oI. 0 1 Nom=;; fRCRA HAZARDOUS WASTE, SOLID 1 CMY =—� r z z SS k 4. - lPt3 5 14. Special Handling Instructions and Additional Information PROF] LE 0 CA€ 08853 15, GENERATOWSIOFFEROR'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 I am the Primary Exporter, I certify that the contents of this consignment canfonn to the terms of the attached EPAAcknowledgment of Consent. I cera fy that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) is two, Gene slofferoes Prin tfyped Name )` Signator Month Oay Year 16. International Shipments Ll '.. F Import to U.S. L1 Export from U.S. Pod of enlrylexlt: Transporter shmature (for exports only): Date leaving U.S.: 17. TransporterAcknowledgment of Receipt of Materials Ul Wa poder 1Pfinledlfyped a Signatur MI t. D�Y Y�r (P ` d Tran poder2 PrintedRyped Name Signature Month Day Year h 18. Discrepancy 18a. Discrepancy Indication"Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181h. Alternate Facility (or Generator) US. EPA ID Number J_ V Facilitys Phone: Month Day Year m 18c. Signature ofAltemate Fault ity (or Generator) Q w10. Hazardous Waste Re od Management Method Codes (i.e.. codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted i61tel8a Printedflyped Name Signature Mo D, Yegr EPA Form 8700-22 (Rev. 3-05) Previou ditions are obsolete. DES90MATED FAO9LITV TO DEgaTONATOON STATE (Ir REQUIR ®)