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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. P e1of 3. Emergency Response Phone 4. Manifest Trucking Numberrpp ��//(( WASTE MANIFEST %#AB t941t t�55�'S5 S c3_33i-24633 015895823 MJ W 5, Generator's Name and Mailing Address Generators site Address (if different than mailing address) ARMI UNIFORM AND CAREER APPAREL LLC 7673 LONGE ST MIbCKTON, CA 952010 GeneratorsPhome:20MM-0105 6, Transporter 1 Company Name U.S. EPA ID Number PHILIP WEST INDUSTRIAL SERVICES 7. Transporter 2 Company Name U.S. EPA ID Number B, Designated Facility Name and Site Address U.S, EPA ID Number CHEMICAL WASTE litoPI1I4A t7 I INC ,Al0117 35264 OLD SKYLINE ROAD ICETTLEP IAN, CA 9:329 Facility's Phone: 800-222-2904 - ga 91 . U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers - 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity wt./Vol. g tl _8 1 . NON RQ-RAS—9AZAC-;E)OUS '.iVASTE, SOLID 1 Cm V 4@2 W 2. ) 1 : 1 1 49 l I i 4. E i 14. Special Handling Instructions and Additional Information PROFILE 0 CAI 15. GENERATOR'SIOFEROR'S CERTIFICATION: I hereby declare fast the contents or this consignment are fully and accurately described above by the proper shipping name, add are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for tr$nsport according to applicable intemagonaland national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent I cer ifythat 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) is true, Generatorslrs P 'ntedlTyp �� J/F - � Signatu � Month Day Year I / - 31 J 16. International Shipments j_ ❑ Import t U.S. ❑ Export from U.S. port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: W 17. TraisporterAcknowledgment of Receipt of Materials w Trans 1 P ' 1 y d Nam _ nature Month Day Year QMW Transporte Printedfrype ame Signa Month Day ar t— .p 18. Discrepancy - 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Re)ecilon ❑ Full Rejection Manifest Reference Number: 18b. Agernate Facility (or Generator) U.S. EPA ID Number J QFacilltys Phone: Month Day Year 18c. Signature ofAlfemate Facility (or Generator) Q , z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal,and recycling systems) ® 2 3. 4 w 1, 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials severed by.the manifest except as noted in item like P'dnfed/fyped Name Sign Month Day Year 3 Z� 1� EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. IDEMONATED FACIL07V T O DESTI MATOON STATS (OLS R EQUO ED)