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— b � 1 q <br /> 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 Numberr® ryry9 <br /> WASTE MANIFEST C:�Lt��1 �1�555 '�-33 -2iruf ® 1 ® C 8 JJ <br /> 5. Gar maloes Name and Mailing Address Generatofs Site Address (if different than mailing address) <br /> ARAMARK UNIFOR€� .AFiS CAREER .�rPt A'REL LLC" <br /> 7,079 LONGE ET <br /> STOC€-:TON, CA 95200 <br /> Generatofs Phone:2f09_234-k31 L 5 <br /> 6. Transporter l Company Name U.S. EPA ID Number ^ y'+av <br /> PHI LfFVVE5T4 € JL:LaBs ?E i'EVECEvarr <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 /> 4aHEn:Rit.;AL 't1 ASTEMANAGENIEf�49 (NC G'�itl45=i(� €i'Z : i <br /> 35251 OLE+ SKYLINE ROAD <br /> KE�17LESrIAN, CA 93239 <br /> Facility's Phone: 300—222-2904 <br /> ga 9b. 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 WtVal. <br /> L f <br /> ® NON RCRA HAZARDOUS WASTE, SOLID Y __42 _4 91_—� <br /> � 1 <br /> i <br /> w 2' <br /> 0 <br /> 3• IL <br /> f <br /> f <br /> 4. <br /> 14. Special Handling instructions and Additional Information <br /> PROFILE 0 CA008852 � <br /> rdA/ <br /> 15. GENERATOWSIOFFEROR'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 intemakonaland national governmental regulations. If export shipment and I am the Primary <br /> Exporter, Icedily that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent. I _ <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) is true. <br /> Generator's/011e rs Pd yped me . Signator Mgn DaW Year <br /> 16, International Shipments ❑ ImLO <br /> F— port to U.S, ❑ Export U.S. Port of enirylexit: <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> 17. TransporterAcknowledgmentofReceipt of Materials <br /> Lis <br /> Transporter l Printed/fyped ,�area Signature Mont tl O Year <br /> C 13L <br /> 3 - ' �l� r 1p OOOF b <br /> 4 Transporter 2 Printedlryped Name S' n jre Month Day Year <br /> r'- <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ quantity ❑ Type ;: ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> r< Facility's Phone: ' <br /> Inc. Signature ofAlternale Facility (or Generator) _ Month - Day Year <br /> Q <br /> N19. Hazardous Waste Report Management Method Codes Cie., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 2. <br /> 3. <br /> 4. <br /> 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a - <br /> PentedrrypedName Signature Month Day Year <br /> kAc 'NA b B � <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. D ETSI GIMATE—D rACCLOTY TO DESTI NA'ti OOM STATE (OF BEAU€RED)) <br />