Laserfiche WebLink
Please print or type. (Form designed for use on elite.(12-pitch) typewriter.) Form Approved, OMB No. 2050-0039 <br /> A UNIFORM HAZARDOUS 1. Generator ID Number 2, Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number pp pp <br /> WASTE MANIFEST CAL6004t3.5595 % r2• '�-33 —2408 015895838 8 NJNJ K <br /> S. Generators Name and Mailing Address Generators SiteAddress (I[ different than mailing address) <br /> ARAMARK UNIFORM AND CAREER APPMEL LLC <br /> 7079 LON E ST <br /> STOCKTON, CA, 952115 <br /> Generators Phone:2E1MM3 0105 <br /> 6. Transporter 1 Company Name U.S. EPA ID Numbe <br /> PHILIP VlrEST INDUSTRIAL SERVICEFe -"' <br /> 7. Transporter 2 Company Name U.S. EPA ID NumberV <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> Cl—PIYtsRE C>�';L WASTE tt7eAf�.C-EPv°IEH.!T INC U.S, <br /> 35251 OLD SKYLINE ROAD <br /> KETILEF,P,r 1, CA 93237 <br /> Facility's Phone: BtDL 22L2904 <br /> ga 9b. U.S. DOT Description (including Proper Shipping Name, Normal Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br /> HM " and Packing Group (If any)) No. Type Quantity Wt.Nol, <br /> 1. 1 <br /> 8 <br /> NON RCRA HA2ARDOUS WASTE, OLID 1 Croq � Y 42 � 491 1 <br /> E <br /> 3. <br /> 4. <br /> 14. Special Handling InsWclions and Additional Information <br /> PROFILE 0 C7a608852 <br /> fep, 4f 1229 � 1� • ®� 10 ® �� I <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment ate fully and accurately described above by thel proper shipping name, and are classified, packaged, <br /> marked and labelediplacarded, 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 cedifythat the waste minimization statement Identified in 40 CFR 262.27(a) (if i am a large quantity generator) of (b) (if I am a small quantity generator) is true, <br /> Generetorsloffe s Pr' tedrr ,(pme <br /> // (( SlgnaWre Month Day Year <br /> --r 16, International Shipments <br /> �.. ❑ Import tc .S. ❑ Export from U.S. Pod of entry/exit: <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> 17. TrenspoderAcknowledgment of Receipt of Materials ' <br /> TransporterdrF e a Signal Month Day Year - <br /> O <br /> 0. <br /> CX Tmnsporter2 Pdntedll'yped me Signature Month ay Ye r <br /> K <br /> F- <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 /> LL Facllily's Phone: <br /> w 18c. Signature.ofAlternate Facility (or Generator) Month Day Year <br /> a <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal; and recycling systems) <br /> m 1 21 3. 4. <br /> 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as Wed in Item Ills <br /> PrinedlTypdNama Signature Month Day Year <br /> {n �f 61 0 � � <br /> EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete, DESIGNATED FAMLITV TO DESTINATION STATE (OF PREEQU ORED) <br />