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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 lO Number 2.,Pa e 1 of 3. Ememency Response Phone 4. Manifest Tracking Number p ry IBJ WASTE MANIFEST C"AL60134 X5695 &144 334- 2408 ® d. ® I ® � NJA1J IP�1 5. Generator's Name and Mailing Address Generatofs Site Address (if different than mailing address) ARA MARK UNIFORM,= AND CAREER APPAREL LLC ' 7670 LONGE ST STOCKTON, CA e15200 Generator's Phone:2M234'0105 6, Transporter 1 Company Name - U.S. EPA ID Numberalt"IAIRWAOSM, PHILIP WEST INDUSTRIAL SERV110ES ey�s 7. Transporter 2 Company Name U.S. EPAID Number S. Designated Facility Name and Site Address U.S. EPA ID Number �:HEP�FIz`..`�-tLWASTE f+71�V"�Iti1[9Et�RE4�i€ INC C443710846197 35261 OLD S€EYL1NE ROAD KET I LENKN, CA, 93289 Facility's Phone: 800-222-20154 9a 91h. 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 any)) No. Type Quantity Wt.N01. 1 f NON RG'I�A F4A7REOl�S WASTE, SOLID1 Clr1 V _� 41. Wz 2. 4. 14. Spaclal Handling Instructions and Additional Information PROFILE @ CA 308852 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 proper condition for transport according to applicable international and 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 unity that the waste minimization statement idenfifled In 40 CFR 262.27(a) of I am a large quantity generator) or (b) (if I am a small cog tK generator) Is true. Genemt9fslQ6e SP '. a ypedN me Signature Month Day Year I � J 16. International Shipments 11 Import to U.S. ❑ Export from U.S. Port of entrylexiC Transporter signature (for exports only): Date leaving U.S.: w17. TranspoderAcknowledgment of Receipt of Materials Tmn 1 PdrtediTy ed e Sign Mon Day Year O b QTmnspo f2 Pdnted/Ty ed Name Signatu Month Day Year a l� 18. Discrepancy 18a. Discrepancy Indication Space Elquantity ❑Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: _ 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U ua.. Facility's Phone: 1m. Signature of Alternate Facility (or Generator) Month Day Year Q z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal,and recycling systems) n 1 , p 3 4 20, Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted In Item 185 PfintedlTy ed Name p� Signature Month Day Year osi 11 EPA Form 8700-22 (Rev, 3.05) Previous editions are obsolete. D(SIGMAYED FA CUTY TO DESTOMAY90N sw=E ((IE nEOumm)