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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2. Pa e 1 of 3. Emergency Response Phone 4, Manifest Tracking Number <br /> WASTE MANIFEST CALEIL1OJIk WMA ", 24 <br /> $44- 44 0L8+ F 015895864 JJ gq� <br /> 5. Generatofs Name and Mailing Address Generator's Site Address (if different than mailing address) <br /> AP,AMAPIK UNI FORM AND 'CAREER APPAREL LLC <br /> 7679 LONGE ST <br /> STDCKTONt CA 96200 <br /> Generatofs Phone:209-734-0110H <br /> 6. Transporter l Company Name U.S. EPA ID Numbe , - ®� � A-J� <br /> PHILIP WEST Cf'SI�Lf.S-.:'Ts--IA SERVICES 04', —c-ems 'd <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 /> e8-iEi't11CAE {Ititla,� t'�— R+3,4f1,�VGEEcr7Et11" INC, U.S. <br /> OLE, SKYLINE ROAD CAT0001340117 <br /> KE3 tL EMAN, CA 93239 <br /> Facllitys Phone: 800-22-2-2964 <br /> go. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br /> and Packing Group if an quanril WUV01. 13. Waste Codes <br /> HM 9 PC Y)) No. Type Y <br /> o NON RCRA HAZARDOUS WASTE, SOLID CM / Y <br /> r , <br /> z 2. <br /> no <br /> I d <br /> 3. `{ <br /> 4. p <br /> ) <br /> I <br /> 14. Special Handling Instructions and Additional Information ', <br /> PROFFILE�Op CA608Ura2 <br /> 15. GENERATOR'SIOFFEROR'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, <br /> marked and labeledlpiacarded, and are In all respects in proper condition for transport according to applicable Intemationaland nal l governmental regulations. if export shipment and l 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 certify that the waste minimization stadment Id ad In 40 CFR 262.27(a) (if l am a large quantity generator) or (h) (ifI am a small qua generator) Is We. <br /> Generatofs/Offerofs Prlate ped Signature Month Day Year <br /> —� 7 IntP61 /7 <br /> ff <br /> _J 16. International Shipmensldz IL ` <br /> t- ❑ Import to U.S. ❑ Export from U.S. Port ofenlryfexil: <br /> Transporter signature (for exports only): Date leaving U.S,: <br /> w17. TranspoderAcknowledgment of Receipt of Materials <br /> E2 TranslaoragislXrintedfryped Name Month Day Y6ear <br /> O �� 6 <br /> a I <br /> M Transpohoug Prin ed/Typed Name Signature Month Day Year !. <br /> I'. <br /> h <br /> 18. Discrepancy <br /> 18a. Discrepancy indication Space ❑ quantity 11 Type ❑ ResiduePartial Rejection ❑ Full Rejection <br /> ❑ <br /> Manifest Reference Number: <br /> 18b. Alternate Facility for Generator) U.S. EPA ID Number <br /> J <br /> V ( <br /> l Facilitys Phone: <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> 6 <br /> 19. Hazardous Waste a ori Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ® 1. 2. <br /> 20. Designated Facili ner or 0 rater: Certification of receipt of hazardous materials covered b the manifest except as noted in Item 18a Y e s <br /> 9 IY Pe P Y P } <br /> PdntedfT ed NamV 1 1 Signature Mo Ih Da Y ar <br /> d <br /> EPA Form 8700-22 ( ev. 3-05) vtous editions are obsolete. <br /> ®1280G �ATrua FAk.m � orms oNATIOM STA:r (#F REQUIF � p <br />