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Please print or type. (Form deslgned for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1, Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking NumberrJ J pp p ��/ <br /> WASTE MANIFEST C>AL0004056915 644-22&2408 015895861 <br /> 5. Generator's Name and Mailing Address 'Generators Site Address (ff different than mailing address) <br /> ARWARK UNIFORM AND CAREER APPAREL LLC <br /> 7679 LONGE ST <br /> MCKTON, C?. 915206 <br /> Generators Phone:269-•2341-C!'13315 <br /> 6. Transporter 1 Company Name <br /> 1 U.S. EPA ID Number <br /> PHILIP _rERVICES CAR669177527 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHE�If CAL 'v`t7ASTE fv�s"1k�tG'E�!IEIVT INC eAE€_s9I3E4017 <br /> 35251 OLD SKYLINE ROAD <br /> KETTLEP AS%J, CA% 93239 <br /> Faculty's Phone: 800-222490-3 <br /> 9a. 91b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Centalners 11. Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity Wt./Vol. <br /> 1. p <br /> NEON I;CRAFAZAROOLISWASTE , � l0�Gil ( S m U v %1 -----i.491__p <br /> w �41 <br /> 3. <br /> € <br /> 4. j <br /> 14. Special Handling Instructions and Additional Information 910 a <br /> PROR LF_ P- CA617'3852 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hambydeclare that the contents of this consignment are fully and accurately described above by the proper shipping name, aril are classified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable infernationaland national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I certify that the contents of this conslgnment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (Ifi am a small quantity generator) Is true, <br /> Generato(WOfferor Printed? e Nam t Signature Month Dacey Year <br /> c � f , � � - 1 117 <br /> J 16. international Shipments <br /> i— [I Import to U.S. ❑ Export from U.S. ori ofenftry/exiC <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> w 17. TranspoderAcknowledgmentofReceipt ofMaterials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> CL, \►j <br /> Tmnsporter2 anteillyped Name Signature Month Day Year <br /> Ed <br /> F- <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication SpaceQ11ResidueElPart1 <br /> Partial Rejection ❑ Full Rejection <br /> LAIRL 11b d s �Ll�❑ €Sgl 11 a ! YPa p� ( ' <br /> _ I Manifest Reference Number: <br /> 18b. Allemate Facili y (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> ra+. Facility's Phone: '.. <br /> w Its. Signature ofA ternate Facility (or Generator) Month Day Year <br /> Q <br /> S <br /> 19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 2. 3. 4. <br /> 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> PrintedRyped Name - -- - -- - - - - - -- - — - Signature -- - - Month Day Year <br /> U 2A U <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DD GMATED HILI TY TO DCSTONAWOO M STATE (IC REQUIRED) <br />