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i <br /> i <br /> I <br /> Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 1. Generator ID Number ZPage i of 3. Emergency Response Phone 4. Manifest Tracking Number p ppgg/�� 1, <br /> WASTE MANIFEST CALt�saC�4ff�.r595 ,� --334-24.%�v 015895833 NJNJ 6� <br /> 5, Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br /> ARAURRK UNIFORM AND CAREER APPAREL LLC <br /> 7079 LOP,SC:E ST <br /> STOCKTON, CA 352001 . <br /> Generators Phone:2M234-01015 <br /> 6. Transporter 1 Company Name U.S. EPA ID NumberCR0 <br /> PHILIPsas'EST ( 4 OUSTROL SERVICES r e5�lrst7e � <br /> 7. Transporter 2 Company Name U.S. EPA IU Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> L HEMI CAL VUAE3TE MAfsAGEMEI J E INC <br /> CXT00004011 i <br /> 35251 OLD SKYLINE ROAD <br /> KETTLEMAN, CA 93239 <br /> Facility's Phone:, 800-222-2984 i <br /> go. 91b. 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.NoI.1. <br /> d <br /> W SY€ON RC:RA f SAZASRDOUS `itVASTE, SOLID 1 CM � © Y' �' 6`i - -P <br /> T. r _. <br /> zz. <br /> — ' — <br /> TL <br /> 4. (¢ <br /> 9 <br /> 14. Special Handling Instructions andAdditional Information <br /> PROFILE 4CAk?36852 <br /> -7 L 499 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the ont nts ofthis consignment are fully and accurately described above bythe roper shipping name, and we 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 I am the Primary <br /> Exporter, I cedify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> 1 certify that the waste minimization statement identified in 40 CFR 262.27(x) (if I am a large,quantity generator) or (b) (If I am a small quantity generator) is lane. <br /> Generator'slOfferors PC ted/Typed Name Signature G--�� Manth Day Year <br /> 17J 16. International Shipments <br /> j.._. Import to U.S. ❑ Export from U.S. Port of entry/exit: . <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. TranspoderAcknoviledgment of Receipt of Materials <br /> T erl Pdntedfiyped Name r Signature Month Day Year <br /> 13� Zc ► 7 <br /> QTransporter 2 Pdnted/fyped Name Signature Month Day Year <br /> r— <br /> 18. Discrepancy <br /> 10x, Discrepancy Indication Space ❑ Quantity L1 Type 11 Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> Zi <br /> U <br /> Facilitys Phone: <br /> w 18c, Signature of Alternate Facility (or Generator) Month Day Year <br /> a <br /> z <br /> y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal and recycling systems) - <br /> 0 1 2, <br /> 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted in item 18a <br /> Pdnted7iyped Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESOGG'iIATE© rRCI LIl TCS ®ESTWAT[W STATE (IF REQUIRE®) <br />