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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. P gel of 3. Emergency Response Phone 4. Manifest Tracking Number pp pppgm� <br /> WASTE MANIFEST :r,�L3(71� 1255 5 8b4..Ra4 -2408 015895819 JJ K <br /> 5. Generatces Name and Mailing Address Genandoes Site Address (if different than mailing address) <br /> ANIARK UNIFORM AND CAPEER APPAREL LLC <br /> 7670 LONGE Si <br /> SMCK.1'ONt CA 95260 <br /> Genemtaes Pho re'AB-234-10185 <br /> 6. Transporter Company Name U.S. EPA ID Number <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 MAF.��',CEf�EfvT INC U.S. <br /> 35251 OL® 13K LINE ROAD <br /> KE€S'LEri CA 9323z <br /> Facility's Phone: 800-,,222-29M <br /> llWlllllllllll <br /> gal 91h. 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 Wt.Nol. <br /> 1. r <br /> o NON RCh'dx, HAZARDOUS wASAE, SOLID 4 erm � `Y' `° 49_1_ .( <br /> — �[{ <br /> 3, t <br /> t <br /> 4. -�- <br /> - -5 <br /> 7 <br /> 14. Special Handling Instructions and Additional Information <br /> PROFILE # CA608852 �• �B�yppg' lI�`p N %/ '�) p/y <br /> 15, GENERATOR' OFFEROR'S CE TIFICATION: ( hereby declarethat the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable maimagonaland national governmental regulations. if export shipment and I am the Primary <br /> Exporter, I cer ily 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 e. <br /> enerator'sl0 farces Pro yped Signature Monies Day Year <br /> _ ( I d <br /> ...r 16. International Shipments <br /> [... ❑ im ort to U.S. ❑ Export from U.S. Pod of enlryfexiC <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> w17 custoderAcknowledgment of Receipt of Materials <br /> tea4 are dY <br /> 'rd , Na llllllSign re Mo9�h y Year <br /> O ✓�J <br /> W Signature Month Day Year <br /> Q r s finte ped Name <br /> F- <br /> .p 18. Discrepancy <br /> 18a, Discrepancy Indication Space El quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 181h. Alternate Facility for Generator) U.S. EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c. Signature ofAilernate Facility (or Generator) Month Day Year <br /> Q <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 /> 20. Designated Facility Owner or Operator: Cerfificalion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdntedfryped Name Signature Month Day Year <br /> D �I f <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. OFpput4.t,V^ED r( (;pLpT1QTO 7E8T@iFTB® iSHfla`FE Or REQUARL�� <br />