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Please print or type. (Form designed far use on elite (12-pitch) typewriter) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4, Manifest Tracking Number p p �/ WASTE MANIFEST CAA GG-4 155'0'9 ' 4-334-2MS 015895862 J J 5. Generator's Name and MallingAddress Generator's Site Address (if different than mailing address) Ai UNIFORM AND CAREER APPAPEL LLQ: 7070 LONGE ST- SjOCKTON, CA 0201 Generators Phmm209-234`0105 6. Transporter 1 Company Name U.S. EPA ID NumberrC➢ R O PIAL IP WEST INDUE31`! AJ. SEPV12CE 7, Transporter 2 Company Name - U.S. EPA IO Number 8. Designated Facility Name and Site Address CU.S. EPA ID Number �sEr�>�ic�,L WASTEn��,r��rv�ervr ( NC C.AT0013040117 35251 OLD SKVL1NE RCAD € El[ LEC,9,AAA, C!s, 03239 Facility's Phone: 8001 2212966 go. 91h. 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 WtWal. NON F:u'!�& RAZAARDOLPE WASTE, SOLID / CM Y C 410 0 6E !4 3. 4. gpgp ) 14. Special Handling Instructions and Additional Information 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above bythe proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable interalionaland national governmental regulations. If export shipment and I am the Primary Exporter, I cer ily that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent I cer ify 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 qua nti generator) is true. GeneratorslOff rs Print y ed N m Signature Month Day Year i yZ lbi I Dt -r IrrWarriallonal Shipm is - ❑ Impod to U.S. ❑ Export from U.S. Port ofentrylexit: Transporter signature (for exports only): - Date leaving U.S.: 17, Transporter Acknowledgment of Receipt of Materials Trans 1 Prime /Typed Name _ Sig re Month Day Year a g� Tramp or PdnteM ped Name SignaNr - Month Day Year B T18. Discrepancy 183. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection 3 T' Manifest Reference Number: l�' 186. Alternate Facility (or Generator) U.S. EPA ID Number v 4yi Facllitys Phone: w 180. Signature ofAlternate Facillty (or Generator) Month Day Year Q N19. Hazardous Waste Report Management Method Codes (le., erodes for hazardous waste treatment, disposal, and recycling systems) 2. 3. 4. 20. Designated Facility OwnerX Operator. Codification of receipt of hazardous materials covered by the manifest except as noted in Item 183 Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous tions are obs ete. € Efflaammm FAA Lim ®EsTmAnom STATE (IF REaum �