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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 Number pp pp pq WASTE MANIFEST r,'.A t010F0>�t055 5 St2.,3_,'�a -24i�8 01 Q� f�a11 IPA 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) fARrkIa4.WRK UNIFORM AND CAPEER APPAREL LLC 76379 LONGE ST STOCKTON, Cit 95205 Generators Phone:289-234-0105 6. Transporter 1 Company Name U.S. EPA ID Number PHILIP IAFEST INDUSTRIAL SERVICES CAR00 917r'527 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address n `, 0.S. EPA ID Number CHEMICALWASTE MANAGEMENTINC CAT000646,117 35251 OLD SKYLINE ROAD= KETTLEMAN, CA . 93230 FachiWs Phone: 800422-201014 ga 9b. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, 10 Number, 10. Containers 1t. Total - 12. Unit 13. Waste Codes HM and Packing Group (if any)) - No. Type Quantity WkA7ol. 1 . o NON RCRA HAZARDOUS WASTE, SOLID I Chi I � Y _ d2l A4 _ 2. 3. 4. 14. 8peclal Hand ling Instructions and Additional lnfmrrmicn - PROF( LE * CA608852 15, GENERAT61TWOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are to and accurately de scribed above by the proper shipping name, and are classified, packaged, i. marked and labeled/placarded, 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 curtly that the contents of this consignment conform to the terms of the attached EPAAcknowledgmem of Consent. I cedilythat the waste minimization statement identified in 40 CFR 262.27(a) (if l am a large quantity generator) or (b) (if I am a small quantity generator is free. Generators(0lferot miledrlype e Signature Month Day . Year i Wal J 16. International Shipments t-• ❑ Impodto . . ❑ 6porthom U.S. Port ofentrylexit: z Transporter signature (for exports only): Dale leaving U.S.: I! W 17. TmnspoderAcknowledgment of Receipt of Materials - Tr port 1 P ' I d bbrand Si ure €. ' Month Da Year - O 'p/ a �/ as Trumps 2 PfimedrFFpaV Name Signalu - Month Day ear h T18. Discrepancy the, Discrepancy Indication Space ❑ quantity _ El Type El Residue ❑ Partial Refection ❑ Full Rejection ! Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number - J <t Facility's Phone: W 180. Signature ofAltemale Facility (or Generator) Month Day Year !,,I Q z i) N 19, Hazardous Waste Report Management Method Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) � 1 � U 2 3 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a !' Pdnted7ryped Name Signature i - MM®� Day Year I! � PA EFarm 8790-22 (Rev. 3-05) Previous editions are obsolete, DESIGNATED FACILITY TO DESTINATION STATE (9F REQUIRED)