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p off <br /> 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. Page 1 of 3. Emergency Response Phone 4, Manifest Tracking Number <br /> WASTE MANIFEST CAL00040559s 844-3a4-246s 015895874 JJ <br /> 5. Generators Name and Mailing Address Generator's Site Address to different than mallam address) <br /> ARAMARK UNIFORM AND CAREER APPAREL LLC" <br /> 7679 LONGE ST <br /> STOCKT��N, CA 95207 <br /> GeneratorsPhone:200 234-0105 <br /> e. Transporter 1 Company Name - U.S. EPA ID Number <br /> PHILIP WEST INDUMIAL SERVICES <br /> 7, Transporter 2 Company Name - U.S. EPA ID Number <br /> B. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHEMICAL WASTE AAAIUAGERAENT INC CAT1200940117 <br /> 35251 OLD SKYLINE ROAD <br /> KETTLEMAAN, CA 93239 <br /> Facility's Phone: 8003 222-290 '.. <br /> ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13, Waste Codes '.. <br /> HM and Packing Group (if any)) - No. Type Quandly Wt./Vol. <br /> 1 CM Y 4$ 491 P <br /> � NON €�CR:A HA7�'sRDfJ�IS 'tf17ASTE, SOLID <br /> 0 <br /> w 2' <br /> 4. <br /> ' � I <br /> 14. Special Handling instructions anclAddlfional Information <br /> PROR LE # CA098852 <br /> 15, GENERATOR'SIOFFEROWSCERTIFICATION: Ihereby 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, I cergry that the contents of this consignment conform to the tens of the allached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement idengfled in 40 CFR 262.27(a) (if l am a large quantity generator) or (b) (if I am a small qua ng nerator) Is We. <br /> GenemtorslOffero sPd yped Of Signature Month Day Year <br /> IF <br /> J 16. Intemational Shipments '.. <br /> j.. ❑ Import to U.S. ❑ Exportfrom U.S. Pa of entry/exit: <br /> Transporter signature (for exports only): Date leaving US.: <br /> D' 17. TransporterAcknowledgmenl of Recelptof Materials <br /> w <br /> Trans oderi Printed/I'yped Name Signature Month Day Year <br /> Co <br /> a g <br /> aTranspoder2 PrinledlFyped Name - Signature Month Day Year �! <br /> F- <br /> .p 18, Discrepancy <br /> 18a, Discrepancy Indication Space ❑ Quantity ❑Type ❑ Residue ❑ Partial Rejection [--] Full Rejection <br /> Manifest Reference Number: <br /> �7 18b. Allemate Facility (of Generator) U.S. EPA ID Number !, <br /> J <br /> U I <br /> ua- Facility's Phone: <br /> W, 18c. SignatureofAternate FaclifitY (or Generator) Month Day Year <br /> 19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> o, 1. / � 2. 3. 4. <br /> 20, Designated Facility Owner or Operator: Certification of receipt ofhazardou materials covered by the manifest except as noted in Item Ise <br /> PrImedffyped Name Signature MonthD Year <br /> EPA Form B700-22 (Rev. 3-05) Previous are obsolete. DESIGNATED FACILITtl TINATI®419 STATE (IF REQUIRED) <br />