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Please. print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-9939 UNIFORM HAZARDOUS 1 . Generator ID Number - 2. Pagel of 3. Emergency Response Phone 4, Manifest TrackQing Number WASTE MANIFEST CAL000405595 1844-334-MB - 015 95801 9 JJ K 5. Generalors Name and Mailing Address Generators Sile Address of cluerent than mailing address) ARAMARK UNIFORM AND CAREER, APPAREL LLC 7679 LONGE ST STOCK.TON, CA 95206 Generator's Phone:209-234-0105 U.S. EPA IENumoar 6. Transpoder I Company Name PHILIP 4`t/E^aT INDUSTRIAL SERVICES 000177527 7. Transporter 2 Company Name US. EPA ID 8, Designated Facility Name and Site Address U.S. EPA ID Number CHEMICAL WASTE MANAGEMENT INC CAT000646117 35251 OLD SKYLINE ROAD KETTLEMAN, CA 99239 Facility's Phone: 800-222-2964 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10.Contalners 11. Tolal 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol. 1. NOS.! RCRA HAZARDOUS WASTE, SOLID 1 Ctvl I �" Y 1491 _-_ sJ IF - 3. 4 14. Special Handling Instructions andAddilional information 1 PROFILE F� 0 CAT308852 O 15, GENERATOR'SIOFFEROR'SCERTIFICATION: 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 prefer condition for transport according to applicable international and national governmental regulations. If expod shipment and I am the Primary Exporter, I codify that the contents of this consignment conform to the terms of the allached EPAAcknowledgmentof Consent. I I certify that the waste minimbrallon statement identified In 40 CFR 262.27(x) (if I am a large quantity generator) or (b) if I am a small quantity generator) Is true, _ Ge Otter PdntedRype m Signature /` Month Day Year lam— ` iJ- 16. International Shipments Ll Import to U.S. El Export from U.S. Pod ofentrylexlC z Transporter signature (for exports only): Dale leaving U.S.: w 17. TranspoderAcknowiedgmenl of Receipt of Materials Tran o 1 Int ypr,�flame Trausp SI re Month Day Year O Lf_ Qo er Pdnled7f ped Name Signal Month Day Year tY .k 18. Discrepancy 18x. Discrepancy Indication Space Quantity ❑ Type El Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b, Alternate Fadli y (or Generator) U.S. EPA ID Number j U LL Fadlity's PhonMonth Day Year e: Do 18c. Sign Fure uAllernale Facility nn Generalarj 6 z N19. Hazardous Waste Report Management Method Codes (i.e„ modes for hazardous waste treatment, disposal, and recycling systems) V /L��/,�J 3. 4. 1 . 1 !/c/ 2 20. Designated Fadlity Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In item 18a Ponled/fyped Neme Signature q2h , Oay� j or FPA Fnrm 870 IRav- 3-051 Previous editions are obsolete. nF;Qlnh1ATFn FANI ITV TO DESTINATION STATE (IF REQUIRED)