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"7 ? p A. <br /> 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. Pagel of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST Cay!00044255@5 844-334-24.158 1 015895807 JJ <br /> 5. Genemtots Name and Mailing Address Generators Site Address (if different than mailing address) <br /> AP tARl4 UNIFORM AND CAREER APPAREL LLC <br /> 71179 LONGE ST <br /> aTOCKTON, CA 952015+ <br /> Generators Phone:209-234-0105 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> PHILIP WEST INDUSTRIAL SERVICES C,AIR00Fj 17 f 527 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number - <br /> 8. Designated Facility Name and Site Address CHEMICAL WASTE MANA[EMEN4T INC U.S. EPA ID Number <br /> 35251 OLD SKYLINE ROAD C.ATL10104€711 i` <br /> KETTLEMAN, CA 98239 <br /> Facilitys Phone: 000»222-29@4 <br /> go. 9b. U,S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br /> 13. Waste Codes <br /> HM and Packing Group (If any)) No. Type Quantity WtNLo <br /> o NON RCRA HAZZ4RDOLiS `BASTE, SOLID 1 CM Y' 491 <br /> 3. <br /> 4. <br /> 66 { <br /> 14. Special Handling Instructions and Additional Information _ {r <br /> PROR LE 0 CAODBO52 <br /> 15, GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare that the contains of this consignment are fully and accurately described above by the proper shipping name, and are classiged, packaged, <br /> marked and labeledlplacarded, 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 I' <br /> Exporter, I certify that the contents of this consignment conform to the tens of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) of (b) (if I am a small quantity generator) is two. <br /> Ge mforsl0((erots PdntedRy e�Na a Sign Month Day Yea . <br /> J 16. International Shipments <br /> r ❑ Import to U.S, ❑ Export from U.S, Pod of entrylexit: <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> WV. TranspoderAcknowledgment of Receipt ofMatedals <br /> Tra poder 1 PriatediTypedNam Signature Month Day Year <br /> CL <br /> zy, Transporter 2 Pnntedflyped Name Signature Month Oay Year <br /> F <br /> 18, Discrepancy ! <br /> 18a. Discrepancy Indication Space ❑ Quantity []Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> '�- 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> U <br /> r+a. Facility's Phone: <br /> w 18c. Signature of Alternate Facility (orGeneralor) Month Day Year <br /> G <br /> Z i <br /> y19. Hazardous Waste Report Maccused Method Codes Cie., codes for hazardous waste treatment, disposal, and recycling systems) <br /> Q 1. - 2. 31 4. <br /> ( <br /> 20. Designated FacIII& Owner .orOpemtor. Codification of race i f hazardous materials covered by the manifest except as noted in Item too <br /> I Printed(fyped Name - Signature M ih Dayr <br /> YI L : ' F <br /> EPA Form 8700-22 (Rev. 3-0 Previou editions are obsolete. DES90 VAT HD FACILITY TO DESTINATION STATE (IF REQUIRED) <br />