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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 10 Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 9 NJpp gg K WASTE MANIFEST C.. L0C10'�0550v SN4-3;3•x.-2466 ® 15 8 9 5 8 3 5 h9 5. Generator's Name and Mailing Address Generafers Site Address (if different than mailing address) AiRiAMir+.R t UNIFORM A`Ar rCAREfER APPAREL LLC 7079 LONGE ST STOCKTON, GA €5205 Generators Phone:209-234-0105 6, Transporter 1 Company Name U.S. EPA ID Numbs PHI LlP 'OVVEST INDUSTIRRIAL SERVO CES J4910 I E n 7, Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S, EPA ID Number CHEMICAL �rVAv-1 E it+iAl+}1�.,•EI4�Eta1T 9ESC' 35251 OLD SKYLINE ROAD, €4ETTLEIVIAN, CA 63239 Facility's Phone: 600-222-2!364 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Centel tars 11. Total 12. Unit and Packln Group (if 13. Waste Codes HM 9 P ( Y)) � � No, Type Quantity wt./Val. @ o NON RCRA HAZARDOUS WASTE, SOL€ 0 1 CM C7 3. 4 @8f t tt k 14. Special Handling Instructions and Additional information PROFILE # CA008652 ! uf lea 0 ` 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contentsofthis consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are In all respects in proper condition for transport according to applicable Intemalionaland 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 codify that the waste minimization statement Idenefed in 40 CFR 262.27(a) (if I am a large quantify generator) or (b) (ifi am a small quantity generator) is true. Generators/Offerors Pfinte�Myped ame rr Signature Month Day Year 1 � \ �?� ^ � � It 121117 J 16. International Shipments F- ❑ Import to U.S. ❑ Exportfrom U.S. Port of entry/exit: g Transporter signature (for exports only): Date leaving U.S.: W17. Transporte -Acknowledgment of Receipt of Materials Transporter 1 dlf ed am Signat Month Day Year O OIL ft GTmnspoder2Prin1 drype Name Signature Month Day Year h .p 10. Discrepancy Its. Discrepancy Indication Space ❑ quantity ❑ Type ❑ ResiduePartial Rejection ❑ Fa Re ❑ )eclion Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA IO Number J U u Facility's Phone: 18c. Signature ofNternate Facifty (or Generator) Month Day Year 19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 4. 20. Designated Facility Ow er or Opemlor. Cer ifcation of recei t othazaN us materials covered by the manifest except as noted in Item 18a `II4 PrintedRyped Name Signature Man Day Yea^r EPA Form 8700-22 (Rev, 3'q Previoruse tions are obsolet . Ear.%IVAMATED rACILI - O ®ESTIMATION STATE (€P REQUORED)