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CMZ9 t1 z TRm# LJHH309 7 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 Tracking Numberr WASTE MANIFEST C LODO4Ef5595 Rd4. 334-2A6Et . 015895803 JJ B'® 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) ARA)MARK UNIFORM AND CAREER (APPAREL LLC 7679 LONGE ST STOCKTON, Cf? 95206 Generators Phone:209-2344)1 05 6. Transporter 1 Company Name - U.S. EPA ID Number PHILIP WEST INDUSTRIAL SERVICES CAROG0177627 7. Transporter 2 Company Name U.S. EPA KD'Number 8. Designated Facility Name and Site Address U.S. EPA ID Number CHEA�ICRL VtrpeSTE MANAGEMENT ENC CflrT010036117 35261 OLD SK`ILINE ROAD KEI L0lAA,N, CA 93239 Facilib/s Phone: 800222-296A go. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity WLNoI. o Ni1f d F?CF•f? HAZARDOUS WASTE, SOLID 1 GM Y _4 - I. 40 -_ W 2 k- � l 3. a t 4. f 14. Special Handling Instructions andAdditioaal Information PROFILE # CA008852 15. GENERATOR'SIOFFEROR'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 tri proper condition for transport according to applicable international and national governmental regulations. If export shipment and l am the Primary a Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent I certify 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 true. Generators/Offerors Primed/lyped Name 31gna1 Month Day Year 1 16. International Shipments 1- ❑ Import to U.S. ❑ Export from U.S. Port of entrylexit: z Transporter signature (for experts only): Date leaving U.S.: w 17. TransporterAcknowledgment of Receipt of Materials SE Transporter 1Printed Name Signature Month Day Year 0 a Transporter Plintedrnlarad Name Signaba.J Month Day Year 3 18. Discrepancy 18a. Discrepancy Indicated Space ❑• Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection t 3 Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number a LL Facility's Phone: w 18c. Signature ofAgemate Facility (or Generator) Month Day Year Q z N19. Hazardous Waste Repoli Management Method Codes I.e., modes fer hazardous waste Treatment disposal, and recycling systems) ® 1. 2. 3, 4, 20. Designated Facility Oder Opera or: 6 ification of receipt of hazardodAnadeflads covered by the manifest except as need in Item 18a I. Printedflyped Name Signature M n ay Year SI I a EPA Form 8700-22 (Rev. 3-05) Previous editions A obsolete. DESMIXIATED FACOUTY TO DESTINATION STATE (IF REQUIRED)