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. <br /> r: <br /> Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050=003f <br /> UNIFORM HA7_AR00OS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone - 4. Manifest Tracking <br /> (�Number <br /> pp //�� -pp' pp Kp/p <br /> WASTE MANIFEST CAI 1100401%135 844-334'2468 V 1 5 ® J 5 ®`3 S'' NJIUJ-g\l <br /> 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) TW <br /> AV<AMAR'IS UNI FL1RM AND CAPEER APPAREL LLC <br /> 71379 LONGE ST <br /> STOCKTON, CA 9520es ; <br /> Generators Phone:2019-224'01435 <br /> 6. Transporter l Company Name U.S. EPA ID Numbe <br /> ;;aFIILIF' WEST INQUSTF;dAL SERVICES <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address CU.S. EPA ID Number <br /> f-IE(v7ILAL WASTEi�ftt��l�.C"r_PJEE6'�IT INC <br /> 35251 OLD SKYLINE P044D <br /> KETii_EMAN, CA 93239 <br /> Facilitys Phone: 8000-222-296-4 <br /> 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br /> 13. Waste Codes <br /> HM <br /> and Packing Group (if any)) No. Type Quantity Wtivol.1. <br /> ® NON RCRA. H ARDOUS ``VAS T E, SOLID 4 CtYr1 � � V � � 4 --� <br /> � 2. � <br /> W ; <br /> 3. <br /> S <br /> 14, Special Handling Instructions and Additional Information <br /> PROFILE O CACIO9352 <br /> ✓�2s p4 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: Iherebydeclare ihaline conteniseft is consignment are fully and accurately described above by the propershipfing name, and are classified, packaged, <br /> marked and iabeledlpiasarded, and are in all respects In propercondiflon fortronsport 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 conslimment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I sanity that the waste minimization statement identified in 40 CFR 262.27(a) (if i am a large quantity generator) or (b) (rfl am a small quantity generator) is two <br /> GeneralotslOff s4/{, rtedlr,/�/en��N mo Signatum / Month Day Year <br /> 76- yYr I moil, <br /> p <br /> J 16. International shipments <br /> f- ❑ Imponfo U.S. ❑ Exporlfrom U.S. Porf of entry/exit: ; <br /> Transporter signature (for exports only): - Date leaving U.S.: <br /> w <br /> 17. TranspcnerAcknowledgment of Receipt of Materials <br /> � Tmnspo r1 do dName Sign a Month Day Year I <br /> � � I <br /> Transporter 2fdote /typed Mine Signatu M nth Day <br /> IB. Discrepancy <br /> IBa, Discrepancy Indication Space ❑ Quantity F1 Type ❑ Residue ❑ Painful Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18h. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> rat. Faci flys Phone: <br /> w 18c. Signature ofAltemate Facility (or Generator) Month Day Year <br /> 2 <br /> z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste Vestment, disposal,and recycling systems) <br /> 55 <br /> 0 1 2. 3. 4. <br /> 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Prityped e Signature Month Day Y"7 <br /> EPA Form 87OO-22 (Rev, 3-05) Previous editions are obsolete. DESMNI TED FAaLITt3 TO DESTIMATON STATE (IF RLQRIRED)I <br />