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Please print ortype. (Form designed for.use on elite (12pltch)_typewriter) __ _ IT IT — _ _ _ _ - _ ,- Form Approved 0MBNo2050-0039 1 Generator ID Number 2 P ge1oP 3 Emergency Response Phone 4 ManifestTracking'Number UNIFORM HAZARDOUS ®® ® � f.5 fi 'p� � WASTE MANIFEST t �,L�11 . 166d156598 , 3, 16o aJ 8 ii J '. 5. Gea rat6rs Name and Mailing Address iGenerdtors SiteAddress (if different than mailing address) '.. P.,R IARK U INI FGRPtr AND .CAR I? APPAREL LLC 7,676 LONGE.;ST STOCKTION, Cit 95203` Geneators Phone`s66 ,�3441 [l IT 6. Transporter Company Name - U.S, EPA ID Number PHILIP '�Ar`ESTIN !1�T�1AL S- MVICES 7. Transporter 2 Company Name US ONu EPAImber B. Designated Facility Name and SibrAddress U.S EPAIDNumber CHEit4IGPLNFP--- - fl - ,� } {TaEPtiEP;l79fJC G1T1Q06[ 641? 52�ra OLD SKIYLiNE ROAD KEl i LEtv9?SV, GA 63'239 ; FaclliF/s Phone: ©less—c96 -.. _.. - _. . _ .. _ . .. _ __ - . 9a. 9b U S DOT Description Including Proper Shipping Name, Hazard Class, ID Number, , 10, Containers, , , : 11 . Total 12. Unit IT 13. Waste Godes pM and Packing Group (rfa0y)) . ! ,No. -Type .,, Quantity WtNol. 1 '.. o NON RCRA HAMROOIJ-9 WASTE, SOLI F) iiN CM 2 4 z 2. i I 3 IT 4. 14, Special Handling Instructions and Additional Infdtrnallon PROF€ LE :Ei CAL5C18852 TV - _ . _ 15. GENERATDR'S10FFERDR'S EERTIFICATIONl iherebytteclare that the contents 6f this consgnment are fullyandaccurately dsadeed above by the propershlppmg name, ahl are classified, packaged, marked and labeled/placarded, and are in all respects In proper condl(ibh for tfah§poft accoldlog to applicable ihte}nagobaland national governmental reguldti66s. If export shipment and lain the-Primary Exporter, I certify that the contents alibis consignment conferee to the terms of the attached:EPA 116wle8gment of Consent. , I codify that the waste minimization statement identified �n 40 CFR NL97(a) (If I am a larg quantity g;4etator) or (b) (itI am a small 'quantfty_generator) is true. _ - _ --.. _ - - � -_. _ . _ . . GenerahlsA) mrs Prl ped e - 8gjhamTe Month Day Year J 16P International Shipments - z ❑ mpod to U.S. ❑ Export from us. Part of ntrylxd: _ Transpotler signature (for exports,only): _ _ Date leaving U.S.: _ w 17,TmnapoderAcknowledgmem of Receipt of Materials 12 Traa lr ri 1 Prime Year CTampons noted typed Name Signaatbr'e` -T - ^""' . �- Month Day Ye t K 18, Di- 7epan6y - _ '. U. Discrepancy Indication Space ❑ quantity [] Type ❑ R idueto ❑ Partial Rejection ❑ Full Rejection Manliest Rearms .Number. ... . . 18b.Altemate Facility (or Generator) U.S. EPA ID Number E5 LL Facllitys Phone: w liluSignalure of Alternate Facility (or Generator) Month Day Year Q N19. Hazardous Waste Report ManagemenlMethod Codes g e codes for hazardous waste Treatment I, an r byclmg_ysteihs) 3. 4. - LII � III 20. D i }nat dFa Ili Owner or Operdtor Cedficahon ofm rpt ofhazardous materials coveted hyth ma f st except bled in Item 8a nmt Pdrrped Name Signatur Month Day Year EPAFann B700-22. (Rev. 05) Previo' % ediflonsat6`obsolete. Og§(O NAIEB .F� 5`6 12, MNATION STATE (W REQUIRED)