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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. GeneratorlDNumbet 2, Pege1of 3. Emergency Response Phone 4. Manifest Tracking Numberrp p �// WASTE MANIFEST cA GG 413h5of 34.4-33'`4-'2k46s8 015895855 NJNJ K 5.Generator's Name and Moiling Address Generators Site Address (if different than mailing address) . f'RASAARK UNIFOIRM! RAID CAREERAPPAREL LLC: 7679 LONGE ST' STOCKTON , CA, 9.52016 Genondoes Phone'209-2844 0103 fi. Transpoder 1 Company Name U.S. EPA ID Number FHILlP kAJETC I NII 1;F f RIAL SERVI CEL C R0001 '• 7527 7. Transporter2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number CHEM! CAL VVAS a TE iH'it 41tAGEMEN r INC ie ATf00004 tl 17 35`51 OLE) SI'.YUNE ROk0 KEt ITLEMAN, CA 932595 Facility's Phone: 8012-222-2904 L go. 9b. 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.Nol. ® NON RC-RA RAZARDOLIS irVASTE, SOLID I C-M � � �� ;4V, - 3. 4 B 4 . - 14. 8pecial Handling Instructions and Additional Information FRORLE 91 C:A CY08652 8 X3'142 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 condilion for transport according to applicable International and national governmental regulations. If export shipment and I am the Pdmary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR26227(a) (if I am a large quantity generator) or (b) QN am a small quangty generator is true. GenemfolslOfferorted Aped Na Signature Month Day Year f < � R i7 —r 16. International Shipments F ❑ Import to U.S, Exportfram U.S. Podofeniry/e><ii: Transporter signature (for exports only): Date leaving ILS,: w17. TransporterAcknowledgmentof Receiptaf Materials S2 Transported PrintedlTyped NameSignature Month Day Year 06 42% ell Transporter2 PnntedJfyped Name Signature - Month Day Year K F- 18. Discrepancy Ise. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Padial Rejection ❑ Fuu Rejection Manifest Reference Number. 186, Alternate Facility (or Generator) . U.S._ EPA 10 Number 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 waste treatment, disposal,and recycling systems) 4. 20. Designated Facility Ower or Operator. Coultmtlon of receipt of hazardous glatetials covered by the manifest except as noted in Item 18a PrintedRyped Name Signature "DayEPA Farm 8700-22 (Rev. 3-U5) Previous editions ar obsolete. - EIEe�E�fT�[� � �EE g y� y ��gg�gpg�Eyy' �TgT