Laserfiche WebLink
Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No, 2050-0034 <br /> UNIFORM HAZARDOUS 1. Generator ID-Number 2. P e 1 of 3. Emergency Response Phone 4. Manifryest Tr ackkiing NNumberr� p p @/( '.. <br /> WASTE MANIFEST CAL0004O5595 0 -uN- - 2. iw ® .L 9 7 5 OJ 2 2 NJJ K <br /> 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) '.. <br /> ARAiMAPK UNI FORM AND CAREER MPPAREL LLC <br /> 7679 LOWEST <br /> ST0CKTON, CA 9620 <br /> Generators Phone:200234 '00 L6 <br /> 6. Transporter 1 Company Name - U.S, EPA ID NumberCAR )k <br /> PHI LIPWEST ING�.tBTRiwLSERI€ C:ES � aGe4 �77E „ II <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> B. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHEN�ilC4AL �sMk2nTE [AAI\I.Jkr.iEMEf\rI INC <br /> 35251 OLD SKYLINE ROAD _;ATt3C1130413-117 <br /> KETZEMAR CA 93239 <br /> . Facility's Phone: 800-M-2064 <br /> ga. gb. 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 Wtivol. <br /> 1. <br /> NON RCRAHAZARDOUS 'WAS tom, SOLI D i mki � , 'y '42V )AGI <br /> w <br /> 3. <br /> t <br /> 4. <br /> t <br /> k <br /> 14. Special Handling instructions and Additional Information <br /> PROFILE 0 CA!308852 <br /> = ' l IS& 0010 Sol <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 cuddly 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) (if I am a small quantity generator) is true. <br /> Generatoror�Pdnte Na Signo> nth Day Year <br /> 17–a <br /> 16, International Shipments <br /> i— ❑ Impart to U.S. ❑ Export from U.S. Port ofentrylexit: <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> 17. TranspoderAcknowledgment of Receipt of Materials - <br /> Tra der 1 Printedfryped Name SI ature Month Day Year <br /> e0 /062 <br /> 0 (� <br /> Tranfiorter2 Prince fryped arae Sign ure Month flay Y ar <br /> tK <br /> T18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 186, Alternate Facility (or Generator) U.S. EPA ID Number '.. <br /> U <br /> r Fa Facility's Phone: '.. <br /> 18c. Signature ofAitemate Facility (or Generator) Month Day Year . <br /> Q <br /> z <br /> h <br /> 1g. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> - ® 1 2. <br /> 20, Designated Facility Owner or Operator: Cerfificatlon of receipt of hazardous materials covered by the manifest except as noted in Item 18a ;. <br /> \II4 Prinled[Typed Name Signature Month f Day Year <br /> E fLLD <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DEMOMATED FACILITY TO D STIHATICki STLB E (fir 1,4 �'rs:gsViR HD) <br />