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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No, 2050-0039 ISI, UNIFORM HAZARDOUS 1. Generator lD Number 2. Page 1 of 3, EmergencyResponse Phone 4. Manifes6 yT�rackping(yNumberr� {� ({ ry WASTE MANIFEST ;.(—€7-11341155d:.�i a� — :�4— . G J ® J ® 4 z# NJWJ I' 5, Generator's Name and Mailing Address Generators Site Address (if different than mailing address) ARANIARK UNIFORM AND CAREER APPAREL LLC 76179 LONGE ST STOCKTO)V, CA. @520CE Generators Phone:209-234$ 0105 6. Transporter l Company Name U.S, EPAIDNumbe -legag PHILIP VVEST INDUSTRIAL SERVICES 7. Transporter 2 Company Name U.S. EPA !D Number 8. Designated Facility Name and Site Address U.S. EPA ID Number - CHEMICAL WASTE r,r9Af1AMMENT INC C 'ATOG00 0117 35251 OLD SKYLINE ROAD I KETTLEMAN, C.A. 93239 I Facilil �s Phone: 801222_2264- 9a, 91% 4S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol. 1. o NON RCRA K&ZA;R DOLFS IrtltASTE, SOLID 1 f ft i � Y a I ( I 2. g , e 3. ; h ( 14. Special Handling lnstmctiuns and Additional lnformatlon PROFILE 4C� gA9013885244 ry uy y p 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this 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 propercondiflon for transport according to applicable international and national governmental regulations. If export shipment and l am the Primary Exporter, I certify that the contents of fhis consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) Is true. GenemlorslORemrs P tedffype /a Signature Month Day Year , c� B7 1 /l t;� d r J 16. International Shipments F-1 j... Import to A. ❑ Export from U.S. Pod of enbylexil: Transporter slgnature (for exports only): Date leaving U.S.: W 17. TranspoderAcknowledgmant of Receipt of Materials Trans Pill ped Name Sign - Month Day Year O a A0 IVYT QTmnspo r2 rinledfryp Name Signature Month Day Year F 18. Discrepancy '.. 18a. Discrepancy Indication Space ❑ quantity F-1 Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection '.,. Manifest Reference Number: 18b. Altemate Facility (or Generator) U.S. EPA ID Number '.. U ua- Facilitys Phone: w 18c. Signature ofNternate Facility (or Generator) Month Day Year d 19. Hazardous Waste Hoped Management Method Codes (i.e., codes for hazardous waste treatment, disposal;and recycling systems) 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manliest except as noted in Item 18a Printed/Typed Name Signature Month . Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. // DESMATED FACOLITV 0 ESTIHATOON DTATIt SOF P EQUIRED�