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II! Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> V UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> 1 WASTE MANIFEST CAL000405595 014-331-2148 0 1 5895871 JJ {C <br /> p 5, Generator's Name and Malting Address Generators Site Address (if different than mailing address) <br /> Ili ARAArIARK UNIFORM AND CAREER APPAREL LLC <br /> d 7479 LONGE ST <br /> STOCKTON, CA 95204 <br /> Generators Phone:20Q-231-0105 <br /> 6, Transporter 1 Company Name U.S. EPA ID Number <br /> d PHI Ll P WEST i NDUSTRIAL SERVI CES CAR000177527 <br /> c <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> ( i <br /> I <br /> B. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHEMICAL WASTE MANAGEMENT INC CAT000444117 <br /> 35251 OLD SKYLINE ROAD <br /> K Tfl_EM.AN , CA 93239 <br /> Facilitys Phone: 500-222-2941 <br /> ga 9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Contalners 11. Total 12, Unit 13. Waste Codes <br /> HM and Packing Group (If any)) No. Type Quantity wt.Nol. <br /> a NON RCRA HAZARDOUS VVASTE, SOLID 1 CM � � Y 491 <br /> I i � <br /> 9 <br /> W <br /> 3. <br /> 4. <br /> t I', <br /> 14, Special Handling Instructions and Additional Information '.. <br /> PROFILE # CA4081352 <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 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 <br /> Exporter, l certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> ® I certify that the waste minimization statement Identified In 40 CFR 262.27(a) (if l am a large quantity generator) or (b) (if] am a small quantity generator) Is true <br /> Generalmrsl0 es P tedlfyp a Signature Month Day Year <br /> � d <br /> 16. International Shipments <br /> j. ❑ impor(lo U.S. LJ Export from U.S. Pod of enirylexiC <br /> z Transporter signature (for exports only): Data leaving U.S.: <br /> JX <br /> 17. TranspolarAcknowtedgment of Receipt of Materials <br /> K Tramp er 1 Printed 'ped Name Slgnalu q 11 <br /> Month Day Year <br /> Z <br /> Tmnspoder2 Primedlfyped Name Signature Month Day Year <br /> F- <br /> 18. Discrepancy <br /> 18a. Discrepancy lndlcatlon Space ❑ Quantity ❑ Type ❑ Residue ❑ Pagel Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPAIDNumber <br /> J <br /> V <br /> u4- Facility's Phone: <br /> oo Iso. Signature of Alternate Facility (Or Generator) Month Day Year <br /> 6 I I I ' <br /> z <br /> N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 1' 2 3 4 <br /> I <br /> 20. Designated Facility Owner or Operator: Codification of receipt ( hazardous materials covered by the manliest except as acted In Item 188 <br /> PdniediTyped Name /:: Signature - Mon 0 y Year <br /> EPA Form 8700-22 (Rev. 3-05) Previous bettlons are obsolete. I DESIGNATED FAgCI DESTINATION STATE (IF REOUIKED) <br />