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Please print or type. (Farm designed for use on elite (12-pitch) typewriter.) Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generator 10 Number 2. Page 1 of 3. Emergency Response Ph= 5895884 <br /> ne 4. Manifest Tracking Number <br /> WASTE MANIFEST CfhL9DL34t1559.�i €�44'33fl_24 n; 015 9 5 4 J69 <br /> 5, Generators Name and Mailing Address Generatut's Site Address (if different than mailing address) '.. <br /> ARA "ARK UNIFORM AND 'CAREER APPAREL LLC <br /> 7679 LONGE ST <br /> STOLE :TON, CA 95206 <br /> Generators Phone:209�234®0105 <br /> 6, Transporter) Company Name - U.S. EPA ID Number <br /> PHILIP WEST INDUSTRIAL SERVICES <br /> 7. Transporfer2 Company Name U.S. EPA ID NumberL <br /> 8, Designated Facility Name and Site Address U.S, EPAID Number <br /> CHEMICAL WASTE MANAGEMENT INC CAT0010040117 <br /> 35251 OLD SKYLINE ROAD <br /> KET7I-Et 1AN, CA 93239 <br /> Facllilys Phone: 8000 222290 <br /> ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 1t, Total 12, Unit 13. Waste Codes <br /> HM and Pacl Group (if any)) No. Type Quantity Wt.Nol, <br /> S E <br /> 0 NON RCRAHAZARDOUS WASTE, SOLID 1 Ch?) <br /> w <br /> 3. <br /> 4. <br /> If II <br /> 14. Special Handling lnsbuclions apdAddltional Information ' �//S � G� � ✓ate, <br /> PROFILE O CAl <br /> %Y2 1212 10 � 9 <br /> 15. GENERATOR'$IOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately bed above by the propershipping name, aM are ciassiged, packaged, <br /> marked and labeledlplacarded, 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 /> Expodey l cedlfy that the contents of this consignment conform to the terms of the attached EPAAcknowledgmentof Consent, <br /> I certify that the waste minlmizagon statement Ideal In 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ff l am a small quantity generator) is true. <br /> Generatorsl0tferors P dl me Signature M Day Year <br /> Ilnl /6 6 <br /> 4 16. Intemailonal Shipments <br /> [I import to 'U'S. ❑ Export from U.S. Port ofenlrylexit <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> W 1T. TranspoqWholknowledgment of Receipt of Materials <br /> Tmnspo 1 nntedfryped Na a Signature / - Month Day. Ye r <br /> n� <br /> M T nsporter 2 PdnledfTyped Name <br /> Systems _ " Month Day Year <br /> r- <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U,S. EPA ID Number <br /> J <br /> U <br /> Facilifya Phone: <br /> w 18c. GignatureofAlternale Facility (or Generator) Month Day Year <br /> 4 <br /> z <br /> ti 19. Hazardous Waste Report <br /> ffManagement Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ®IUD1 2 3, 4. <br /> 20. Designated Facility Owneror Operator. Ceriificaliono celplo hazardousmeledaiscmeredby the manifest exceptas noted in ll the <br /> Prmledffyped Name Signature Mon ih Day, r <br /> Yea <br /> EPA Form 8700-22 (Rev, 3-05) Prea4cirs editions are obsolete, DESIGINI TED ALiTV TO DESTINATIOM STATE (IF REQUIRED) <br />