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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, Pae 1 of 3. Emergency Response Phone 4. Manifest Tracking Number pp pp <br /> WASTE MANIFEST . ;a:AI_t]00405585 P. 8474-830.2408 015895829 NJNJ K <br /> 5. Generators Name and Mailing Address Generators Site Address (H different than mailing address) <br /> ARNAARK UNI FORMA AND CAF EER APPAREL LLC. <br /> 7670 LONGE ST <br /> STOCKTON, CA 95200 <br /> Generators Phone:2t]L2_M3 0i05 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number '.. <br /> PHILIP WETriNDUMT€AI. SEt VICES C.AR00011 752f <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address GU.S. EPAID Number '..CHEMICALWASTEMANAGEMENT INC <br /> 35251 OLD SKYLINE ROAD <br /> KEMLERMA3, CA 932999 <br /> Facility's Phone: 8001-222-2900 ' <br /> go. 910 U.S. DOT Description (including Proper Shipping Name, Hazard C)ass, ID Number, 10. Containers 11 , Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity. Wt Aral. '.. <br /> ® h`gt]€`SI RCRA E-IAA✓'_a`' PDOUS WASTE, SOLIDI 'i MA � V 4-91 ' - J <br /> w Z. <br /> I <br /> 3. <br /> 4. <br /> 0 t <br /> 14. Special Handling Instructions and Additional Information - d 3vL� u� c$' 61C�q ' ti zo <br /> PRsOF3 LE a ❑?.508852 7'fca,� ( �D� �2 5 " �P 2511-12 <br /> 15. GENERATOR'SIOFFERORBCERTIFICATION: I hereby declare that the contents of this mnsignmentare fully and accurately described above by the proper shippingname, ani are ciassiged, 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 I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify thatthe waste minimization statem nt iderdiijedlin 40 CFR 262.27(a) (if i am a large quantity generator) or (b) (if I am a small quantity generator) Is We. <br /> Generators/,lls Pd d/Typed N e i Signatu Month Day Year <br /> ✓ ` 1t ' '7 <br /> r 16. International Sfipments <br /> T— El import to U.S. i ❑ Export from U.S. Pod of entry/exit: <br /> Z Transporter signature (for exports only): Date leaving U.S.: <br /> D' 17. TranspoderAcknowledgment ofReceipt o atedals (i <br /> w <br /> Transporter Printed/Typed NameSignator , Month Day Year <br /> 1 <br /> 1 1 '111 <br /> f .,' <br /> Transporter 2 Printedrryped Name Signature Month Day Year <br /> K <br /> t— <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Spew ❑ 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 /> i Fadlity's Phone: <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> 4 <br /> *55 <br /> z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 3. 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 /> PrintedRyped Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DEMOMATOD FAVIL11TV TO DDSTINATOON STATE (IF REQUORED) <br />