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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 ID Number 2, Page 1 of 3. Emergency Response Phone 4. ManiferystTracki®ng Number® 7 ry p p� WASTE MANIFEST C,€3L a - E�.�i ° 4:5"U:a 2'� 0 1 5 ® 9 5 © 4 1' N1N70� 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) '.. ARAMARK UNIFORM AND CAREER APPMEL LLC 7679 LONGE ST CTOCKTONt CA 95200 Generators Phone.200-M131 05 6. Transpoderi Company Name U.S. EPA IDNumber �� ®2E9 � PHILIP ViEST ENDUSIPUALSERVICES Ja 7 '.. 7. Transporter 2 Company Name U.S. EPA ID Number '.. 8. Designated Fac18ty Name and Site Address U.S. EPA ID Number CHUM CAL WASTE ��EAGEnnr=r�r INC CKi�0;30401 1 7 35251 OLD SKYLINE ROAD KETTLERMI, CA 93'239 Facility's Phone; 91]I]-'�2�-2f�k'�r9 9a 96, U.S, DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if No. Type Quantity WWol. f o NON RCRk R&2ARDOU+ WASTE, SOLIDi Ch l j V ' =- _9-1 4d d _. k6 14. Special Handling Insfuctlons and Additional Information PROFS LE :4 C-AC OSS52 122a ICI �Vo� 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents olthis consignmen 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 International and national governmental regulations. If export shipment and l am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmem of Consent. I certify that the waste minimization statement idemffed in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true, GeneratorslOfferors 'ntedrFyped,N SignaWre Month " Day Year C,y✓a^ 1 /VLJ C � a Z .-t 16. International Shipments F Elimportfilu.s. ❑ Export from U.S. Port of entrylexit: Transporter signature (for exports only): Date leaving U.S.: w 17. TmnspoderAcknoMedgment of Receipt of Materials '.. TransporterI Pdrfyped Name zr ,r Signa a -r Mon Day Year O TrarspreteaXPrIngeoUlypeaNaree Signature Month Day Year ',, 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181h. Alternate Facility (or Generator) U.S. EPA ID Number '.. J U ❑�- Facility's Phone: '.. W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z 19, Hazardous Waste Report Management Method Codes I.e., codes for hazardous make treatment, disposal, and recycling systems) 1. ( 2. 3. 4. 20. Dbsignated Facility Owneror mtor. CeNfcatlon of receipt of h ardous materials covered by the manifest except as noted in Item lea Printedflyped Name Signature Me �ay� Year sof EPA Form 8700-22 (Rev. 3-05) Previous editions re obsolete. DESIGNATED FFa�BLBTi1 u DESTONATOOM STATE (OF REQUIRED)