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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) m Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS L Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. M rifest Tracking Number WASTE MANIFEST CAL000J05595 $BS'33�3'2 52 ® 15 95 9 JJ 5. Generators Name and MailingAddress Generators SlieAddress (if different than malting address) ARAMARK 7579 LOftRtaE ST STOCK TOM CA 05206 Generators Phrne:209-234-0105 6, Transporter Company Name U.S. EPA ID Number PHILIP WEST INDLISTP.-IAL SERVICES CAR000177527 7, Transporter 2 Company Name U.S. EPA ID Number B. Designated Facility Name and Site Address U.S. EPA ID Number CHEMICAL WASTE MANAGEMENT INCu�:Tt�00,34Si9 � 7 55251 OLD SKYLINE ROAD 14E I TLE IAN , CA 93239 Facllilys Phone: 800-2224904 go. 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 (if any)) - No. Type Ji Quantity Wt.Nol. 1. 4 r W NON RCRA HAZ(( RDOLIS WASTE, SOLID 1 CM � � Y 142- W ' 4. yE 14. Special Handling Instructions and Additional Information PROFILE ® CA608852 r � C; ® " 15, GENERATOWS(OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, aid 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 conform to the terms of the attached EPAAcknowledgmant of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Ge tors/Offerors Primadltyped Name Signet Month �y Year e. C(7 -i 16. International Shipments y.. ❑ Import to U'?. ❑ Export from U.S. Port ofentry/exit: Transporter signature (for exports only): Date leaving U.S.: X 17. Transporter-Acknowledgment of Receipt of Materials Transporter 1 Pri�nted/typed Name Signature Month Day Year CL L:5'1 41, QTransporter 2 Prialedlfyped Name Signatu Month Day Year , a F- 18. Discrepancy 18a. Discrepancy Indication Space .❑ Quantity ❑ Type ❑ Resldue ❑ Partial Rejection ❑ Full Rejection a Manifest Reference Number: 18b. Alternate Facility (or Generator) 0.S. EPA ID Number i J U rai facllitys Phone: { VIA 18c. Signature of Alternate Facility (or Generator) Month Day Year Q I Z N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 4. \3z 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item Ise PdWedryped Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTIINK O M STATE (IF REQUIRED)