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Please print or type. (Form designed for use on elite (12-pitch) typewriter) Form Approved, OMB No. 2050-0039 UNIFORM HAZAR000S 1 . Generator ID Number 2. Pagelof 3. Emergency Response Phone 4, Manifest Tracking Number WASTE MANIFEST - CALOOO405695 / &W334" 88 015895868 JJ K S. Generators Name and Mailing Address Generators Site Address it d m ent man mailing address) Al UNIFORM AND CAREER APPAREL LLC 7079 LONGE ST STOC!{TON, CA 9520O Generators Phone:2O9-23M`01 O5 6, Transporter 1 Company Name U.S. EPA ID Mumble PHILIP NAllEST INDUSTRIAL SERVICES , 7, Transporter 2 Company Name U.S. EPA ID Number B. Designated Facility Name and Site AddressU.S. EPA ID Number GHEMICAp k`ttASTE �st.�la,3E14iE6�s�' ! [+9G CAT'.',0c�si4O9 'l7 35251 OLD SKYLINE ROAD KET LENIAN, CA 93239 Facilil 's Phone: 800-222-2964 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Tolai 12. Unit 13. Waste Codes HM and Packing Group (If any)) No. Type Quantity Wt.Nol. 1. F NON RCRA HAWWASTE, SOLID / cm 2 ;' "'t 49i _-i Z. W �T- � 1. 3. 4 14, Special Handling Instructions and Additional Informalion PROP!'L�gE�y�y� CAGOGS52 y 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described aboveby 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 i am the Primary Exporter, I really that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment 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) (ifi am a small quantity generator) Is true. Generators/Offerors Pd edlTypedl (a /'J bignature Month Day Year g3 ty -+ 16. International Shipments F— ❑ Import to U.S. ❑ Export from U.S. Pod ofenlrylexit: z Transporter signature (for exports only): Date leaving U.S.: 17. TranspoaerAcknowledgment of Receipt of Matedals K Transport tedfry ed Name �f Signa Month Day Year a V U) d- Transporter rinted[ Iype Name Signat Month Day Year t- 18. Discrepancy 18a, Discrepancy Indication Space ❑ Quantity [-] Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) _ U.S. EPA ID Number J U LL Facilitya Phone: Ca 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z N19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) C3 1, 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a ill(. Print typed Name Signature o th Day .Ye `4 G ka EPA Farm 8700-22 (Rev. 3-05) Previous edillons are obsol te. DEMONATED FACILITY TO DESTIMKIHION STATE (IF REQUIRED)