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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. M(ap�ifest Tracking[N7umberr All per/ <br /> WASTE MANIFEST CAIL000405r5�5 84€l—:�'r"a�SG � l6 1 5 8 7 5 ® 1 5 is l If�1 <br /> 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) <br /> APAMAARK UNIFORN7 AND CAREER APPAREL LLC <br /> . 7079 LSt OE ST <br /> , T±�"`.'t ON, CA 95230 <br /> Generators Phone:20P 2.34 10105 <br /> 6. Transpoder l Company Name U.S. EPAID Number <br /> PHILIP V� EST ? NOUS RA;' SERVICES CAR-0601775V <br /> T Tram podor2 Company Name - U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number . <br /> Ci-6&ACAL WA.S1E 11 AK(Ax'aE61dE!` l INC CATODOW011 i <br /> 30251 OLD SKYLINE RJA0 <br /> KET LEP Aldi, CA 93239 <br /> Facilil is Phone: BIQM22�2904 <br /> 9z 9b. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, ID Number, 10. Containers it. Total 12. Unit 13, Waste Godes <br /> HM and Packing Group (if any)) No. Type Quantity Wt.W <br /> ® <br /> NON RCRA HAZARDOUS tPl SOLID9 <br /> all y H 14011 , <br /> W 2 <br /> J <br /> 4. { <br /> 14. Special Handling Instructions and Additional Information <br /> PROFILE O CA008652 <br /> Aft . U aOVIAO <br /> 15. GENERATOR'SIOFFEROWS 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 internafional 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 EPAAcknowledgmenlof Consent. <br /> I certify that the waste m irraff aflon statement Identified In 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small qua rotor) Is true. <br /> GeneralorslOffis Pn'nt�d(Ty ed'�a�e ( Signature -Month Day Year '.. <br /> :r 16. International Shipments '.. <br /> i- ' ❑ Im_ podto U.S. . ❑ Export from U.S. Padofentrylaxil: <br /> Transporter signature (for expods,gitly): Date leaving US,,,. <br /> W 17. TransporterAcknowledgmenl 61keceipt of Materials <br /> 11"ons o ' `dflyped N Sig ere Month Day Yrear <br /> Si nater Month Day . Year <br /> aTrans der 2 Pl !typed Name 9 <br /> W <br /> 18. Discrepancy <br /> Its. Discrepancy indication Space El Quantity [—] Type ❑ Residue ❑ Partial Rejection LI Full Rejection <br /> ManifestReference Nu'rt)Uer, <br /> Inn,Alternate Facility (or Generator) U.S. EPAID Number '.. <br /> U <br /> Facililyzs Phone: <br /> aw iec. Signature ofAltemate Facility (or Gederaftr) : <br /> 1Month Day . Year <br /> z <br /> y19. Hazardous Waste Report Management Method Codes (ILA, codes for hazardous waste treatment, disposal, and recycling systems) <br /> ® t 2 3' 4, <br /> 20, Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prinledffyped Name Signature Month Day Year <br /> °� f UZ ➢� <br /> EPA Form 8700-22 (ReV. 3-05) Previous editions are obsolete. FWZC ff TV T® "©FSTOHXTIOM STAW (OF REQUERED) <br />