Laserfiche WebLink
�` IIIIIlIIlI !II'll'lIIII'IIIIIIil�I BIlll IIIIIIIIIIlI II! <br /> Please print or type. Form Approved.OM8 No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number Z.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number <br /> WASTE MANIFEST CAL000427616 1 877577669 01 97610 F LE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(it different than mailing address <br /> Bath & Body Works 15110 Bath & Body �orks#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> Generators Phone: STOCKTON, CA 95207 STOCKTON, CA 9507 <br /> 6.Transporter I Company Naas . U.S.EPA ID Number <br /> Ste ricycle Specialty Waste Solutions Inc MNSOOOI10924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Worldwide Recovery Systems CAROOOP5422 <br /> 8.Designated Facility Name and Site Address Yuma Y e 5, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facility's Phone: AZRO( 0515924 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit <br /> HM and Packing Group(if any)) 13.N.raste Codes <br /> No. Type Quantity Wt.r'VoI. <br /> 1. Non RCRA hazardous waste, solid (Soaps, 1 DF 00134 P 331 <br /> Lotions), <br /> - — --------- - - <br /> 1 <br /> =- <br /> 2 Non RCRA hazardous waste, liquid (Soaps, 1 DF 00128 P 331; <br /> Lotions), - j— - <br /> 3, <br /> f ! <br /> 1 <br /> 4. <br /> f 1 <br /> 14.Special Handling Instructions and Additional Information 1. 110' 03(State Regulated Solids) 2. 110902(State Regulated ` <br /> Liquids): <br /> O 3 <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,ant are classified,packaged, <br /> marked and labalod/placarded,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 POmary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quanfity generator)or(b)(if I am a small quantity generator)is true. <br /> Genera oeslOfferor's Printedfryped Name Signature re Month Day Year <br /> Atf <br /> •1 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> ce 17.Transporter Acknowledgment of Receipt of Malenais <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> LrO <br /> a 191212113 <br /> CAP Transporter 2 Prin ed/Typed Name Signatur Month l Day Year <br /> lol <br /> L:c3l <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El <br /> Quantity ❑Type 11 Residue ❑Partial Rejection ❑Ful!Rejection <br /> Manifest Reference Number <br /> F 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rQ Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Mouth Day Pear <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.a.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ <br /> d 1. W- u7i 1 Z. 3. 4. <br /> 20. gnated Facility Owner or Opera for.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pried yped Name_ Signature Month Day Year <br /> 1-fic Ll 4/ <br /> EPA Form 8740-22(Rev.1 -17) revrous editro s ar obsolete. DESIGNATED FACE!ITY TO EPA's e-PytANIFEST SYSTEM <br />