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Please print or type. (Farm designed for use on elite (12-pitch) typewriter.) r Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. GeneratorlDNumber 2. P el of 3. Emergency Response Phone 4. Manifest Tracking Number pp pp ��//(( WASTE MANIFEST CAL-000405505 844-334-24& 8 - 015895857 NJNJ K 5. Generator's Name and Mailing Address Generatoes Site Address (if different than mailing address) APMARK UNIFOREil AND CAREER APPAREL LLC 7679 LONGE .ST STOCKTON, CA 05200 Generator's Phone:2099 234-0105 6. Transporter i Company Name U.S. EPA ID Numbe PHILIP \QSTINDUS- NIAL SERVICES 7, Transporter 2 Company Name U.S. EPA ID Numbery 8. Designated Facility Name and Site Address -cU.S. EPA ID Number �tE�r1EC�L WASTEn�7�,sx!�,�•Er�ENT INC 35251 OLD SKYLINE RaikD Chi G1 ��b�31 i 7 liETTLENAAN, CA, 03239 Facllilys Phone: 55C-222-•2®64 - go. 91b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total Q. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity WLNOL t NON RCR,A 64AARCCUS WASTE, SOLID ON CIA 20 Y - A 491 J _ z 2. i CD ad F 4. 14. Special Handling insimfctions andAdditienal information PROFILE # CACOS852 �y ¢�/ 15. GENERATOWSIOFFERDR'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 l am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAckn9wledgment of Consent. I codify that the waste minimization statement Identified In 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is free. Generafor's/Offeror's Pri orifi me Signature Month Day Year -J 16. ImernaflonaT61blipmords r ❑ Import to U.S. ❑ Export from U.S. Port ofentry/exit: 1 Tomsportersignature (for exports only): Date leaving U.S.: w 17. TranspoderAcknowledgment of Receipt of Materials - 0O Transpc 1 Printed/pyped No Sig re Month Day Year BTran ads ringed ypad Nae Signature 9 Month Day Yeir F T18. Discrepancy 18a, Discrepancy Indication Space ❑ Quantity L1 Type El Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Fadlity (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 i 19. Hazardous Waste Report Management Method Codes (Le,, codes for hazardous waste treatment, disposal, and recycling systems) 0 1. 2. 3. 4. ifis 20. Designated Facility Owner or Operator. Codification of receipt of hazardous materials covered by the manifest except as noted in Item iso Pnntedfi'yped Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) P161ous edithiths are obsolete. DlFa mAno rLiNLIgV S® ©ESTONATIOM STATE (IF REQUIRED)