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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. DMB No. 2050-0039. <br /> UNIFORM HAZARDOUS 1, Generator ID Number 2, Pae 1 of 3, Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST <br /> rALI'1Gf0406595 s -33 -1468 015895802 JJ <br /> 5. Generalm's Name and Mailing Address Generators Site Address (if different than mailing address) <br /> ARAMARK UNIFORM AND CAREER APPAREL LLC <br /> 7670 LONGE ST <br /> STOC'KTON, CA, 95206 <br /> Generators Phone:209-234 Q0105 <br /> 6. Transporter i Company Name U.S. EPA ID Number <br /> PHILIP yVEST INDUSTRIAL SERVICES v ICAR00017762 7 <br /> 7. Transporter 2 Company Name US. EPA ID Number <br /> B. Designated FWilly Name and Site Address U.S. EPA ID Number <br /> CHEMICAL WASTE MANAGEMENT INC CATOCl3646117 <br /> 35251 OLD SKYLINE ROAD <br /> KETTL EMAN, QA 03239 <br /> Facility's Phone: 8000-222-2964 <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 Quantity WfArol. <br /> 1. G <br /> NON RCRA HAZA,P.DOUSWAS`IE, SOLID ". CM � V _ C 491__� <br /> — I <br /> Z 2. i <br /> 3. [ <br /> r <br /> 4. <br /> 14. Special Handling Instructions and Additional Information <br /> PROR LE # CA608852 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accumlely described above by the proper shipping name, and are classified, packaged, <br /> 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 <br /> Exporter, I cortify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmentof Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if] am a small quantity generator) is true. <br /> GeptoeslOfferoes Pr' hr yped N7me Signal e - Month Day Year <br /> i Vj I JR / A �' <br /> —r 16. International Shipments ' <br /> z. ❑ Import to U.S, ❑ Export from U.S. Pad of entry/exit <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> w 17. TranspomerAcknowledgment of Receipt of Materials i <br /> Transp or 1 P ' ted yped No SI ature Month Day Ye .r <br /> O <br /> a <br /> 7d- Transporter2Printedrifired Name Signa Monlh Day Year <br /> � 1 <br /> t- <br /> T18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quamly ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> rat Facility's Phone: <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> Q 7 <br /> z <br /> w19, Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) i <br /> 1. 2. 3. - 4. <br /> ( <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 B ;( <br /> Primedfryped Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITV TO DESTH6JATIOIU STATE (IIS REQUIRE®) 'r <br />