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Please print or:type. <br /> I! l� Il ► ldl�1111 !! lfll� <br /> '.Geneator ID Number ?o_ FGrm Approved.ONAB No.2050-0039 <br /> U <br /> NIFORM HAZARDOUS _ 7e or 3 Emoraancy P.espense?hone 4.MnnirestTracking Number <br /> EMANtFES7 CAL000427b16 1 g7%5J7�669 01 962806 ��� <br /> Generator's Name and 6tail ng Address Generator's Site Address(if oiffarent than.maillrg addresst b <br /> Bath & Body Works 1510 Bath & Body Glor-kslic <br /> 7;9339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> Phone: STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> t Company Nama <br /> Stericycie Specialty Waste Solutions Inc US.NS@0011 <br /> ter 2 Company Piame <br /> MNS000110924 <br /> U.S.EPA ID Number <br /> Worldwide Recovery Systems CAR000175422 <br /> d=aci-ity Name and site Address Yuma Yes, <br /> US ;3AID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> =ac{uvsPhone 9286428938 "on-1 <br /> g, go U S DOT DC5copro- iincl-dir„^,Proper Sh!pcirg parr _ <br /> Hazard Class.IC:'cumber, <br /> -ItA 31M:acx;ng Group--.an t; 10.Con;arrers <br /> Uri; <br /> % Type Quae+„r Tt VC f'.Waste Cies <br /> Cr Non RCRA hazardous waste, solid (Soaps, 1 DF 0 1 4 <br /> Lotions), <br /> w <br /> z 2 <br /> !cWa <br /> 3 <br /> I � <br /> ff <br /> 14.Spec:ai Nand6ng InstruCIVIS aro Addn.cnal Infeena on (�g0J a:e .e[],.i cl 2 0 I ids) <br /> I <br /> 1S <br /> GENERA70R'SJ0FFER0R'SCERTIFICATION: I hereby del-fare that the contents of ins a,gnntani are fu5y and ac ra eiy de dr.bed acaz by he propar sr ppird moms,and are Uassirlad,packaged, <br /> marked and-oeledfp,acarded,and are n all•aspects in proper ce�cdirr fcr rarspor accord,.g to apphcot_e vemat,cn.n and^a lona;gdvemmentat regutabons.if expon pip,ert and,am!re Frimzry <br /> Exporter,I certify that the contents of J arvgnmert conform-o ire to ms or he at.ached PAAckrarr edgn..t d <br /> I cenih•. - Coraert <br /> hat the haste minowtaten statement:denVed is 40 CFR 152 27;aj IA;am a large goantry genera!orl or .i <br /> a ib)( am a -all G arity eneratcr,s ime. <br /> r eremtddsOtfero?s PrintedTyped Name <br /> S.grab;re r el:p an e a a l m l a Vicrtn Day Year <br /> 6.InMmai;nnai Sh-pments r— 02 27 201 <br /> r LJ impor:to U S <br /> ? harspe:;er signature i'cr excor.;o-1y): --Exdort`rom U.S_ Pon Gi ertry;exit <br /> Date leaving U.S.: <br /> T,.nspode:Actnw:iedgmert of Recs.pt of F,!aterials <br /> gTransposer 1 Prin!edr tyaed Name <br /> Signature, <br /> a. Kristopher Almanza Nfan-^ Day Year <br /> Z tans r 2 P;!e?yyeo Na1c �� 02 27 201 <br /> Si:p;a <br /> t•– �(, a ,Y�Y(� - K�C1`E� �- ..��� tdon!t Day year <br /> ha Di_=crepancy Indica9en Soace — <br /> Quantiy I Tywe <br /> Reside E!—l�L:Pan;ai RdacGca ,�,'� <br /> Fu!I Rejection <br /> .F 18b.Aite•rate Fac lily jr Ge^.eratG;i .ar!fesi ti9`KBncc Number <br /> 1S EPA.'�.L':;mcer <br /> U <br /> u- FaCih^(S PFdna. <br /> � tt';._Signature of A,ternate Faculty cr Genera!ort <br /> Q t+?dnih Day 'fear <br /> 2 <br /> C0 19 Hezaro `xVas:e Rero G{anayement N7 had Codes 4.a.,Bodes icr hazardo;svasfa;tea ment.dist= a!,acri recd firs sys; <br /> w Ts; <br /> O 7 1. <br /> 5 <br /> tri.^Designated Facii,fy 0+:-er or Cperaior.Ceri`-caion of receipt of hazardous ma!eriais cceered by the,n2nifos!except as acted-r,dem 18a <br /> arirted!Hyped Name <br /> ' Slynatur <br /> J `nth Day fear <br /> E?A F rm 8',3�22 tRev. 12-17) Previous editions are obsolete 1. <br /> DE IGN ED FACILITY TO EPA's e-MANIFES SYSTEM <br />