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- - _ r <br /> Please print or type. (Form designed for use on elite (12-pitch)'Iypewriter.) K t - Form Approved. OMB No. 2050-0039 <br /> A UNIFORM HAZARDOUS 1 1, GeneratorlD Number 2, Page 1 of 3. Emergency Response Phane 4. Manifest Tracking Number <br /> WASTE MANIFEST CALLIGO1055g5 0 844 334'2468 8 015895856 J�1J K _ <br /> 5. Generator's Name and Mailing Address Generators Site Address (if differafit than mailing address) <br /> AR MALAR€4 UNIFORM AND CAREEP APPAREL LLC <br /> 7679 LONGE ST <br /> STOCKTON, CA 95200 <br /> Generators Phone:2109_2&4_01 Q5 <br /> 6. Transporter 7 Company Name U.S. EPAID Number <br /> PHI Ll P VVEST I NDLISTMALi SERVICES CAR000177527 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and SlteAddress U.S. EPAID Number <br /> 3.5251 ( C:LD S'KYLI N f� ith[`•tPGE41lEi Sl' INC CAT OL11646117 <br /> 35251 C}L93 SKYLINE ROAD <br /> €SETTLEMAIN, CA 93233 <br /> Facility's Phone: 000-222-2954 <br /> ga 9b.U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity Wlivol. <br /> 1. <br /> o <br /> NON RCRfA HAZARDOUS SWASTE, . - �' C1U 9 Cm AO Y <br /> U � � <br /> 2, i l <br /> 3. <br /> F r <br /> 4. <br /> 14. Special Handling Instructions and Additional Information ` L .. drr <br /> PRORLE4CAB+133852 �Vf-04Ur VSPgII '72 . <br /> Gia s kP 3 <br /> 15: GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name, aM are classified, packaged, <br /> 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 <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I codify that the waste minimization statement identified In 40 CFR 262.27(a) (if I am a large quantity generator) or @) of I am asmall quan2 generator) is true, <br /> Generatofsl9(feror Panted d arae - Signature Month Day Year <br /> J 16, InMildbAl Shlpments <br /> r— ❑ import f U.S. ❑ Export from U.S. Port of entrylexll: _ <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> EX 17. TmnsporterAcknowledgment of Receipt of Materials <br /> Tans orter l Printedfryped Name Signature Month Day Year <br /> 1101 3ij 11I <br /> MTransporter Peruser typed Name Signature - Month Day Year <br /> h <br /> 18. Discrepancy r� El <br /> 18L 11 <br /> �e. Discrepancy ndicali�space ��uantiW rJ „ 66(4 c p SPT_ ypg( h r 1 ( Q &J� �SEl p0ial Reject y J Frll� ec ion <br /> Manifest Reference Number. <br /> 78b. Allemate Facllity (or Generator) U.S. EPAID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c. Signature ofAltemate Facility (or Generator) Month Day Year - <br /> a <br /> z <br /> 19. Hazardous Waste Report Management Method Codes f e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 7. 2. 3. 4. <br /> 20. Designated Facility Owner or Operator! Codification of re elpt of hazardous materials covered by the manifest except as noted in item l8a <br /> Piinlecirryped Name Signature Month Day Year <br /> G <br /> EPA Form 8700-22 (Rev. 3-05) Previou editions are obsolete. n��o�n.unFr� r_aa s�xs Ova c��rc9rnna rasravan® a? rn � ruff r�rseao nom 'sax. <br />