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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 1. Generator ID Number 2. Pagel of 3. Emergency Response Phone 4. Manifest Tracking Number pp �Op� '.. WASTE MANIFEST CAL 001�N06595 34+1—,�34-240Y� 015 ® mJ 5842 M� If\1 5. Generators Name and MaillagAddfes5 Generators SileAddress (If different than mailing address) MAMARK LI(\jll-'C$RWANLr CAPEEP APPAREL LLC 7079 LONGE ST STOCKTON, C? 95205 Generators PhondW� 234'010"i - 6. Transporter 1 Company Name U.S. EPA ID Numbs PHILIP VVEST Ii DUSTIRIA;L SERVICES �•�, r n . 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number - 362ER�I L lsKVLIla ��A.I�!AC;EAfEI�ITIIUC =.4T1?0r04�3117 5451 f�LC} SI{4LI [�IE Re7F�1 KETTLEf12AN, 0k 93230 Facility's Phone: 800_222-2904 go. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12- Unit HM and Packing Group (if any)) No. Type Quantity WtJVa. 13. Waste Codes P E NON RCRA. HAZARDOUS WAS-1-E, SOLID I cm y Lwgr 49"1 W 2. 4. u E 14, Special Handling Instructions and Addittonal Information PROR LE 4- C-At~08852 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare thatthe contents of this consignment are fully and acc tsly described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condigon for transport according to applicable International and national governmental regulations, If export shipment and I zm the Primary Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I, I certify that the waste minimization statement Identified in 40 CFR 262,27(a) Of I am a large quantity generator) of (b) (if I am a small quantity goner tor) is true. Generators1016orsPd ad Signature Month Day Year r 16. International Shipments ❑ Import to U.S. ❑ Export from U.S. Porlofenirylexit F ':. Transporter signature (for exports only): Date leaving U.S.: w17. TrensporterAcknowledgment of Receipt of Materials Tran o rt ed yped Name ��' Signal Month Day Year 0 l`J' rGy y Z Transport r2 Printed ed Name Signature 7 Month Day Y r 18. Disompancy 189. Discrepancy Indication Space ❑ Quantity []Type ❑ ) ❑ Full Rejection Residue Pallial Rejection Manifest Reference Number. 1 an.Alternate Facility (or Generator) - U.S. EPA ID Number J U LL Facilitys Phone: W Its. Signature of Alternate Facility (or Generator) Month Day Year Q 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. 2, 3. 4. 20. Designated Facili"wne rOperator.. Certification of recelpt of hazardous materials covered by the manifest except as need in Item 18a j IontedRyped Name I Signature Month Day . Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. - o ©G�a�O ��O®� STATE (OF REGUM )