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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) - Form Approved, OMB No. 2050-0039 UNIFORM HAZARDOUS 1, Generator ID Number 2. PI 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CA�+.L00111�1755 5 ' " -24�d 015895889 JJ K S. Generator's Name and Mailing Address Generatots Site Address (if different than mailing address) ARA.114AW UNIFORM AND CAREER .APPAREL LLC 71179 i`C11� E ( STOC'r<.TON, CA 95206 Generator's Phone:2n151-234—l11 05 _ 6. Transporter 1 Company Name U.S, EPA ID Number VV®2 ,f�'el� PHILIPVVESI iNDUSTRIAL. SERVICES B� �® 7. Transporter 2 Company Name U.S. EPA ID Number 8, Designated Facility Name and Site AddressU.S. EPA IO Number CHEIte7ICAL WASTE MANAGEMENT INC CFt't00004011 i 3601 OLD SKYLINE ROAD 10ET LEIVIA�S, CA 03233 lPhone: 3©F1-222-2CiE�4 9, 9b. 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)) aaaaaaa No. Type Quangty WlAte. 1. J= . 1 O NON RC RA H: ZARLCOUS 'xVA I E, SOLID ? 9 22 1` G�9 .. ...�..—___. W 2 I 3. ) 'Q 7 14. Special Handling Instructions andAddilional Information �� 'r 74&&7 1 40 PROFILE CABG8452 7 14 614F&7 15. GENERATOR'SfOFFEROR'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 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 Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknmviedgment of Consent. I sentry that the waste mmimkz tion state ent Identified in 40 CFR 262.27(a) (fif I am a large quantity generator) or (b) (If I am a small quantity generator) is true. Generate ro 7 rinted a NameSignature Month Day Year 1. F t t J I U' =+ 16. lnternagona Spmenls J Impo to U.S. El Export from U.S. Pon of entrylexit: z Transporter signature (for exports only): Dale leaving U.S.: W 17. '0ansponow nerAckledgmenl of Receipt of Materials t2 TmnsponerI yped//N�rame y� / Signature Month Day Year GO 4 Transporter 2P ted[Typed Named a Signature Month Day Year .Ip 18. Discrepancy I 18a, Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) US. EPA ID Number J U Facllitys Phone: -ea 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) Q 1 2 3. 4. . ±157 .� 20. Designated Facility Owner or perator: Certification ofreceipof hazar s materials covered by the manifest except asnotedin Item 18a Perdedriyped Nam a Signature Month Day Year EPA Form 8700-22 (Rev. -051 Previou dtmms are obsolelb. DESOCINATEED FACILITY ESTOINIATOOOM STATE (OF REQUIRED)