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Please printer 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 ((N°��u fmI�bberr pp pp ��/(/ WASTE MANIFEST CAL0004T559k6 >'�Q ',:$-29k}ct 0152995811 5 611 IUJRJK S. Generators Name and Mailing Address Generator's Silo Address if different than mailing address) - ,WAAA RK UNIFORM ANID CAREER APPAREL LLC 7074 LCNrET STOC o CN, 6A RR200 Generators Phone:2099 22.E-,010v 6, Transporter I Company Name - U.S. EPA ID Number I - FHILIPkAr STIItDUSTRIALSERVICES CAR000177527 7. Transporter 2 Company Name - U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number CHEM ICAL , MST E MMAGEIVIEN'r INC CA,TLID0040117 3525'1 OLD SKYLINE ROAD KETTLEAAAN, C;.A, 23232 Facilitys Phone: 800.222.2204 9a, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit HM and Packing Group (if any)) _ No. Type Quantity Wtivol. 13. Waste Codes 1. R Q® NON RCRA HAZARDOUS WASTE, SOLD 9 CAM � Y � r 2.n1 s K I , w ; I w q f r 3. yp 4 4. I 14. Special Handling Instructions andAdditlonal Information - I PROFILE ft CA@08852 9 15, GENERAOR'SIOFPEROR'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 labeledlplasarded, 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 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 262.27(a) (if I am a large quantity generator) or b) (ifI am.a sm I quaptV generator) Is true. Gen for Offerors , nn yped Name Sig MonUt Day Year J 16. In conal Ship is Im❑ rtto U.S, F— Import ❑ Export from U.S. Port of miry/exit: Transporter signature (for exports only): Date leaving U.S.: w 17. TransporterAcknowiedgmentof Receipt of Materials Ila rte yped Na Suse Month Day a QI'mrsplaterViindeBTed Nam Sign a Month Day ear l F- 4. 18, Discrepancy 18a, Discrepancy Indication Space ❑ Quantity []Type ❑ Residue ❑ Partial Rejection [] Full Rejection I Manifest Reference Number: 18b. Alternate Facility (or Generator) _ U.S. EPA ID Number J !.J LL Fadlltys Phone: is 18c. Signature of Alternate Facility (or Generator) Month Day Year li R 8 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted in Item 18a ' PrintedfFy ed Name Signature Month Day Year ue Y`�P Opt p3 ! 1 EPA Form 6700-22 (Rev. 3-05) Previous editions are obsolete. , DEMNATED FACHLITV TO DESTINATION STATE (OF REQUIRED)