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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 CALOCFIU405695 . 844= 33$42J468 015895814 JJ <br /> 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) <br /> ARAJMRK UNIFORM AND CAREER A'PAPEL LLC <br /> 7@79 LONGE ST <br /> •TOCjTON, CA 95206 <br /> Generators Phone:211 23441105 - <br /> B. Transporter l Company Name U.S. EPA ID Number <br /> PHI LIP WEST il�ll3i.SL'�TII�,L EERIrlC;Ew CA,RD9G 177527 <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 WASTE MANA04EMENT INC CAT0900401 17 <br /> 36261 OLD SKYLINE ROAD <br /> V E17LEMA 11, CA 93239 <br /> Facilitys Phone: 600-22'_=`-2994 <br /> ga 96. 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)) No. Type Quantity WLNol. <br /> 1 �'. `. t Y '�' 9 <br /> p <br /> NON RRA HAZARDOLiO �A ASTE, SOUR 1 Chi / �T <br /> 3. r <br /> 3 <br /> 4. - <br /> 14. SpeciatHandling Instructions andAddifionai Information <br /> PROR LE 0 CAll <br /> 122®/5'ld ®®/ <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 to applicable international and national governmental regulations. If export shipment and l am the Primary <br /> Exporter, I sedgy [hat the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I codify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br /> GenemtorslOHerars P ' teded ame Signature Month Day Year <br /> J 16, International Shipments <br /> F- ❑ Import to US. ❑ Export from U.S. Pod of entrylexit: <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> w 17. TransporterAcknowledgmem of Receipt of Materials n <br /> Theories d dlf pZia <br /> ed Name Si lure Month Day Year <br /> QTransporter 2 PrmtedrFyppJdName Slgnalu Month Day Year <br /> K <br /> 18 Discrepancy <br /> 188. Discrepancy Indication Space <br /> Quantity Type Ll Residue <br /> ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 166. Alternate Facility (or Generator) U.S. EPA ID Number <br /> .J <br /> U <br /> r+a. Facility's Phone: <br /> w 18c. Signature ofAltemate Facility (or Generator) Month Day Year <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ® 1. - 2. 3. 4. <br /> ( ' 2, . <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered bythe manifest except as noted nItem 18a Mo Day Year <br /> Prokid)fyped Name ('�'"'Y� � signature <br /> EPA Form 8700-22 (Rev. - revlo editions are obsolete. EEB(GNATEDFACiLI i0DESTMATIONSTATE (OF112O99RE <br />