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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 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone . 4. Manifest Tracking Number <br /> WASTE MANIFEST CALOOO4O55I35 5441 334-2Q.88 0 5895809 JJ <br /> 5. Generators Name and Malling Address d Generators Site Address (it different thanmailing address) <br /> AR.AMARK UNIFORM ANDCAREER APPAREL LLC <br /> 7673 LONGE ST <br /> STOCKTON, CA <br /> Generators Phone'209-234-8100 - <br /> 6. Transporter lCompany Name U.S. EPA ID Number <br /> PHILIP WEST INDUSTRIAL SERWICES I QXR0004 77527 <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 SKYLIN ROACE� ENT INC CAT0110H40117 <br /> 35251 OLD SKYLINE ROAD <br /> KETTLEN W4, CA 832301 <br /> Facility's Phone: 800-222-2904 <br /> 9a. 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)) -.Na, Type Quantity Wtivol. <br /> 1: <br /> NON RCRA, HAV\RD0US WASTE, SOLID 1 cv 'Y _4Rr <br /> 3. ) <br /> 4. i <br /> 1 <br /> 1 <br /> i <br /> 14. Special Handling Instructions and Additional Information <br /> PROFILE # CA008852 <br /> 15, GEN RATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents ofthis consignment are fully and accurately described above by the proper shipping name, and are classilled, 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 <br /> Exporter, i certify that the contents of this consignment conform to the terms 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) or (b) (ifI am a small quantity generator) Is true. <br /> Gen pr ors(Offerors PrintedRyped lame Signalgre ., Month Day Year <br /> r-A 2_ lam ' a 2 � f� <br /> J 16. International Shipments <br /> i— LI Import to U.S. ❑ Export from U.S. Port ofenlry/exit: <br /> z Transpodersignature (tor exportsonly): Dale leaving U.S.: <br /> w 17.TransporterAcknowledgment of Receipt of Materials <br /> K <br /> O Tr p eri Printed{ yped Nam Si ature loopOay Year <br /> 2 <br /> A i) <br /> Z <br /> Trans p er rded ped re Name - Sign Month Day Year <br /> 4E I <br /> 18, Discrepancy <br /> 18a. Discrepancy Indication Space Quanlity 11 Type ❑ ResiduePartial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Allemate Facility (or Generator) U.S. EPAID Number , <br /> J <br /> U <br /> LL Facllityls Phone: <br /> w Tic. Signature of Alternate Facility (or Generator) Month Day Year <br /> Q <br /> Z <br /> C) 19, Hazardous Waste Report Management Method Codes (I.e., codes for hazardous waste Uea4 t. disposal, and recycling.systems) <br /> O 1. g'9 2. 3. 4. � <br /> 20. Designated Facility Owneror Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a ) <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIdNATE® FACOLIT Y TO DESTINATION STATE (IE REQUIRE®} <br />