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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 20500039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4, Manifest Tracking Number WASTE MANIFEST 1 ,C A I A 0 n A 0, 18635276 JJ K 5. Generator's Name and Mailing Address Genemtars Site Address (if different than mailing address) ARAMARKLAUNDRYSE ICES 7679 LONGE STREET STOCKTON CA VSM Generators Phone: 6. Transporter Compo" Namy U.S. EPA ID Number '.. PHILIP WEST INDUMAL 7. Transporter 2 Company Name U.S. EPA ID Number '.. 8. Designated Facility Name and Site Address U.S. EPA ID Number WASTE MANAGEMENT, INC° KE Ti TLE FALLS 36251 OLD SKYLINE ROA® Fa P' Ii 1MAN CITY CA 3 ' ga. 9b. U.S. DOT Description (including ProperShlpping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity WINoI. t. gO NON MCRA HAZARDOUS WASTE, SOLID K z 2. w c7 3. 4. 4 14. Special HandlinglosUuctionsandAdd!Uonallnformaaln PROFILE CA608852 MB 'NUMBER 122 -1510- 0010— J0001 15. GENERATOR'SIGFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shippingnme, aid 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 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization gummed Identified in 40 CFR 26227(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) is true. Generators/0 sP telly - Signator Month Day Year IAT/ _ . 16. International Shipments •fR8 F ❑ Import 10 .S. ❑ Exportfrom U.S. Port of entrylexk: Transpodersignature Ar exports only): Date leaving U.S.: 17. Transporter Acknowledgment of Receipt of Materials Tra 1 Printedly ed Name - Si re r Mo Day Year a i AwAe 6 Trans er dntedlf ed Name Sign Month 'flay Year X r18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity El Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Allemate Facillty (or Generator) _ U.S. EPA ID Number - J a) Facilitys Phone: w 18c. Signature ofNternate Facility (Or Generator) Month Day Year Z N19. Hazardous Waste Report Management Method Codes (i.e., odes for hazardous waste treatment, disposal, and recycling systems) . 0 1, 2. - 3. 4• 20. Designated Facility Owner or Operator: Codificationofreceipl of azardous materials covered by the manifest except as noted In Item 18a Printedlfyped Nama Signature Mont Day Year EPA Form 8700-22 (Rev. 3-05) revious editions are obsolete, DESIGNATED FACILITY TO DESTINATION STATEeff REQUIRED)