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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST C.AL0004.06595 J $44-3131-2463 015 8 9 5 8 0 5 JJ <br /> S. Generato 's Name and Mailing Address Generator's SileAddress (if different than mailing address) <br /> ARAMARK UNIFORM AND CAREEP APPAREL LLC <br /> 7679 LONGE ST <br /> S-TOCKTON, CA 962015 <br /> Generators Phone:209-234-01136 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> PHILIP WESTINDUSTRIAL SERVICES CAR000177627 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHEMICAL WASTEt�A,NNA6t=s"�fiEPdT 1 NC CAT000134@117 <br /> 35251 OLD SKYLINE ROAD <br /> KETt'LEMAN, CA 93239 <br /> Facilltys Phone: 'r}aurJ-222-2004 <br /> 9a. . 9b. U.S. DOT Description (Including ProperShipping Name, Hazard Class, ID Numher, 10. Containers 11, Total 12. Unit <br /> HM and Packing Group (if any)) No. Type Quantity WLNoL 13. Waste Codes <br /> L <br /> o NON RCP-.A HAZARDOUS WASTE, SOLID 1 Cm3o Y ^_� `. 1_49'[ <br /> I.. . E <br /> W p, <br /> 0 <br /> 3. <br /> _3�...�_,. _. <br /> 4. € <br /> 14. Speclai Handling Instructions and Additional Information <br /> PROA LE # CA608366 <br /> 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, <br /> marked and labeled/placarded, and are in all respects In proper condition for transport according (o applicable international and national governmental regulations. Westport shipment and I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the agachad EPAAcknowledgment of Consent. <br /> I ceNlythat 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 true. <br /> atorslOfferor's PrintedRyped Name Slgnat Month Day Year <br /> J <br /> 16. International Shipments ❑ <br /> i< Import to U.S. —IF Import from U.S. PortofenhyleAt. <br /> Transporter signature (for exports only): Date leaving U.S.: I' <br /> w 17. TmnsporterAcknowledgment of Receipt of Materials A <br /> T porter t Printed7ryped Name 3�—� Si are ( <br /> 11,01 Ih Da Yea <br /> QTransporter 2 Printed yped Name Signature - Month Day Year <br /> r'- <br /> 18. Discrepancy �! <br /> 1 <br /> Ina. Discrepancy Indication Space ty El Rejection <br /> ❑ Quantity El El Residue J ❑ Full Rejection { <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) US. EPA ID Number r <br /> I <br /> LL Factlitys Phona: <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> a <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes Q.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 1. 2. <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdntelfryped Name Signature Month Day Year <br /> rZLft I M $-� 111 1 zz 1 <br /> EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete. DESMIUA'FEE FACILITY TO DESTINATION STATE (IF REQUIRED) d <br /> d <br />