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Please print or type. (Farm designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Pagel of 3. Emergency Response Phone 4, Manifest Tracking Number WASTE MANIFEST CA000405,590P 1 1844-3244466 015 3 9 5 3 3 3 JJ 5. Generator's Name and Mailing Address Generators Stte Address in amerent Than mailing address) ARAt RK UNIFORM AND .CA.REER APPAREL LLC STOCKTOLONN CAA 952176 Generators Phone:240n234-01165 6.Transporter i Company Name U.S. EPA ID Number . rq R, 17 PHILIP WEST INDUSTRIAL SERVICES 7. Transporter2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number GHEPrfif CAL WASTE MF'9NkCE4l�rle4x.FG INC CAT0370646 1 1 r 35251 OLD SKYLINE ROAD KETTLEMAN, Cry 2323.9 Facililyzs Phone: °GCt_2S2�2L�64 go. gb. U.S. DOT Description (Including 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 Wt.Nol. I o ' NON RCRA HAZARDOUS WASTE, SOLID 1 CM / Y 421= �91 -.� E pf Z 2. C 4. 4 {{ — 9 ( 14. Special Handling Instructions and Additional lnformafon PROFILE g- CAA608652 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, 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 cedify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimlzation statement identified In 40 CFR 26227(a) (if I am a large quantify generator) or (b) (if I am a small quantity generator) is blue. Goof slORemr Prince R ped Name SI lure. / Month Day Year wZY 16. International Shipments F- Ll import to U.S, ❑ Export from U.S. Port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: w17. TmnspoderAcknowledgment of Receipt of Materials .K T oderl Pdnfedlyped Name Signature Month ' Day Year 0 d 8 a Todommer2 Protect typed Name Signature Month Day Year 4. 18. Discrepancy - 18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181h. Alternate Facility (or Generator) U.S. EPA ID Number J E5 tai. Facility's Phone: w 18c. Signature ofAl(ernate Facility (or Generator) Month Day Year a z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal;and recycling systems) 2' 3. 4. 20. Designated Facility Owneror Operator. Certification of receipt of hazardous mat rials covered by the manifest except as noted In Item 18a Printedffyped Name - SlgnaWre M nth. Day Ye El EPA Form 8700-22 (Rev. 3-05) Previous e I ton are o olete. D SMNATED FAC Lp - ESTINAIROON STATE ff REQUIRED)