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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved, OMB N0. 2050-0039 UNIFORM HAZARDOUS 1, Generator ID Number 2, Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Numberp p p/� WASTE MANIFEST C .L� tYr21' 0 o$k—"a0z2=x 015895863 IUJJ K 5. Generator's Name and MankragAddress Generatofs Site Address (if different than mailing address) RA1MARK UNIFORM AND CAREEN APPAREL LLC 76070 LONGE ST STOCKTON, CA @5200 Generatofs Phone:20PM3 i 0105 6. Transporter 1 Company Name U.S. EPA ID Numbs PHILIP WEST INDUSTRIAL SERVICES 7. amsporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address CU.S. EPA ID Number I'EE4?lllaV:kL 'Jt�K54'� fV"tf�('��+'�fi~�t�PJT ! NCadAT+4503rdW97 35251 CLD SKYLINE ROAD O ET-sLEt4. AN, Cly 03230 Facllil I's Phone: 8011,2<`y-2904 ''..,. ga. go. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11. Total V. Unit 13. Waste Codes HM and Packing Group (if any)) No. Typo Quantity Wf.Arol. (20/ I x NON RCRA HAZARDOUS WAST E, SOLID � Vtbg_t r0 SOLI 2 S J�L 3. { p t rid I pp I 4. 14. Special Handling Instructions and Additional Information P'ROR LE 0 CA508852 / a 12 de 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descrithad abarto by the proper shlpping 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 EPAAcknowledgment of Consent. I certify 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 true. .. Generator t - dated drOlamelt, Stignafure // Month Day Year Z 16. Inkarmor al Shipments ❑ Imps fo U.S. [] Export from U.S. Pori of enirylexlt: Transporter signature (for experts only): Date leaving U.S.: V1 17. TmnspoderAcknowledgment of Recelptof Materials Transp IPrinted ped Name Signa Month Day Year Transpoof 2 ntedRyp d Name Signator Monti Day ear 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: i'- 18b. Alternate Facility (or Generator) 45. EPA ID Number J U Facillty's Phone: w 18c. Signature ofAitemate 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) ® 1. 2. 3. 4, 20. Designated Faclll Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted in item 18a Palms l'yped Name Signature Month Yp EPA Form 8700-22 (Rev. 3-05) Previous editlonsare obsolete, OE�SlQ, ' ATED FACILITY TO DEST01MATOON STATE (OF REQUIRED)