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Al 3M <br /> Please print or type. (Farm designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No, 2050-0039 <br /> UNIFORM HAZARDOUS ', Gen rotor ID Number - 2. Pagelof 3, Emergency Response Phone 4. Manifest Tracing Number pm <br /> WASTE MANIFEST CAL0C 0405525 8g '844. 334-2406 015895886 J JK <br /> 6. Generator's Name and Mailing Address Generatofs Site Address (if different than mailing address) <br /> ARAIWARts UNIFORM AND CAREER APPAREL LLC <br /> 7 079 LONGE ST <br /> STOCKTO f, CA 96206 <br /> Generators Phone:209'234"0105 <br /> 6. Tranepoder 1 Company Name U.S. EPA ID Number <br /> PHILIP WEST INDUSTRIAL SERMES _ .74f <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Fadlily Name and Site Address U.S. EPA ID Number <br /> CHEMICAL WASTE ��A��a:GEr,�$ENT INC csaTOL1004e'33 7 <br /> 35251 CLC) SKYLINE ROAD <br /> €CETTLEMIlAN, CA 93$39 <br /> Facllilys Phone: 10,00022L_290;1 <br /> ga. 9b. U.S. DOT Descdpfion (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 Quantity WUVrI. <br /> 1. 3 <br /> NON RCRA HAZARDOUS WASTE, SOLID 1 Cm Y _ 8 do_tn--1 <br /> W 2. <br /> gggg{ <br /> 3. S <br /> 4. I ( <br /> 14. Special Handling instructions and Additional Information <br /> PROR LEA # CA6088v2 <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, pack aged, <br /> marked and labeled/placarded, and are in all respects In proper condition fortransport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I cera fy chat the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent. <br /> I certify chat the waste minimization statement idenfifled in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) is We. <br /> Generalorsl0fferors P ted/Fyprd'N�{g6 ! / Signatur Monty Day Year <br /> E7 4V/J//f ( C <br /> -r 16. International Shipments <br /> F- ❑ Imponto U.S. ❑ Export (rom U.S. Port ofenirylexil: <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. TmnspoderAcknowledgment of Receipt of Materials _ <br /> Tran derI Printed(fyped Name Signature Month Day Year <br /> OV <br /> M <br /> GTmnsporter2Printed1Fyped Name Signature Moth Day Year <br /> K <br /> t- <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Relociion ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Aramaic Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> <a Facilllys Phone: - <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> Q <br /> 0 <br /> w19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ® 1. 2. 3. . 4. <br /> 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by tha manifest except as noted in Item 18a <br /> PrintedlTypSignature Month Day Year <br /> ed Name <br /> v(� dc Dq .�6 I� <br /> EPA Farm 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />