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i rUka,a 'Please print or type. (Form designed for use on elite (12-pitch) typewriter.) - Farm Approved. OMB Nq. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page lof 3, Emergency Response Phone4. ManifesfTracking Number WASTE MANIFEST CAL000405a95 — "� 0 .15 6 9 5 6 6 9 JJ 5. Generator's Name and MallingAddress Gemnator's Site Address (if differentthan mailing address) - APAMAPK UNIFf RIA AND CAREER APPAREL LLC 7079 LONGE ST STOCKTON, CA 95206 Generators Phone,209-234-0105 6. Transporter l Company Name U.S. EPA ID Number PHILIP WEST INDUSTRIAL SERVICESrw 7. Transporter 2 Company Name U.S. EPA tD Number B. Designated Facility Name and Site Address U.S, EPA ID Number CHBOI CAL WASTE NWAGEMENT AGEMENT INC C;AT0000 8 31 17 35251 OLD SKYLINE ROAD KETTLEMAN , CA 93239 Facility's Phone: 80[1-222-2964 ga 9b. U.S. DOT Description (InoNding 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 Wuve. 1. NON RCRA HA•74.RDOLIS WASTE, SOLID i am F Y 4R?� � 491__ 0 - - z 2. 3. c� E 14. Special Handling Instructions and Additional information PROFILEr-. CA308552 16. GENERATOR'SfOFFEROWS 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, marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable international and national governmental regulations. If expert shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. SII. I certify that the waste minimization statement identified in 40 CFR 262,27(a) (if l am a large quantity generator) or (b) (ifi am a small quantity generator) Is tend. Generaloes/OBerorsP ntedRyp Nam Signature Month Day ` Yea l 3� tdy �A 16. International Shipment i— Import to U.S. � ❑ Export from U,S. Port ofentry/dxll; z Transporter signature (for exports only): Date leaving U.S.: W 17. TransparterAcknowledgmenloFReceiptof Materials K Too oder 1 PdntedrTyped Name signature Month Day Year !.,. QTransporter anted/typed Name Signature Month Day Year .Ip 18. Discrepancy I Its, Discrepancy Indication Space ❑ quantity ❑Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b;Altemate Facility (or Generator) U.S. EPA ID Number J ' U ' LL Facilitys Phone: w 18c. Signature ofAternate Facility (or Generator) Month Day Year j y10. Hazardous Waste Report Management Method Codes (t.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4. 20. Designated Facility Ow r or Operator: Codification of receipt of h mdous mat rats covered by the manifest except as noted In Item 18a Pnnteffyped Name Signature Mo Oa Year EPA Form 8700-22 (Rev. 3-05) Previous @fions are of te. DESIGNATED FACILITY TO DESTINATION STATE (IF RE�@91RR®)