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Form Approved.OMB No.2050-0039 Pleaseprint or type.(Form designed for use on elite(12-pitch)typewriter.) UNIFORM HAZARDOUS i Generator ID Number 2.Page 1 of 3.Emergency Response Phono 4.Manifest Tracking Number F L E WASTE MANIFEST AL00@427616 775774669 O 11392817 ailing address} 5.Gonerator's Name and Maifng Address eneratas ite address(if different Than m Bath & Body Works 1510 Bath R Body Works#1510 094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE Generator's Phone: T CA 9 @7 STOCKTON CA 95207 U.S.EPA ID Number b. ransporler i Company Name jigmele Specialty Waste Solutions nc NS000110924 U S.EPA ID Nvm..t— ?Transporter 2 Co pony Name AR000175422 8. U.S.EPA 10 Number Designated Facility Name and Site Addres YUma Yes, LLC 2730 E. 13th Street Yuma, AZ 85365 FaciiitvsPho ZR@00515924 9b U.S.DOT Oesaiplicn(includ.ng Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Una 13,Waste Codes 9a. Quantity 1Nt.:Vci. HM and Packing Group iifanY;) No. Type 'ion RCRA hazardous waste, liquid (Soaps, 1 F @0127 P 331 otions), W1 F @134 F' 331 n RCRA hazardous waste, solid (Soaps, Lot ions) 3 i l 14,SoacialHandling nstruclionsand Additional lnormationl� 11@9@2(State Regulated Liquids) 2. 110903(State Regulated Dl ids) `��J (` 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contenls of this consignment are fully anal acccrateiy described above by the proper s-:ppirg rame,and are classified,packaged, marked and labetedtplacarded,and are:n al respects in propercondil:en for iransput according to applicable international and aatlonal governmental ragulelions.If export shipment and I am the Primary Exporter,I certify that the contents 01 J'is consignment conform to the terns of the attached EPAAcknowledgment of Ccnsent I certify that the waste minimizaton statement identified in 40 CFR 262.27(a)(c I am a large quantity generator)o:im);:f I am a sma7 cua. ratur)is tree. r, ay ear vera enols nnted yped erne gna CL a fg_ d f L i m i t e.. —�-� 16.Inter^al anal hipmenls Import to U.S. Export from U.S. Port of entrylexil: - Transporter signature for exports en.`: Date leav n U.S.: W 17.Transporter Acknowledgment of Receipt of Materials aril � ransponer 1 rinte ype Name gna re ay Year C6 lristopher Almanza Z Transporter inledfTyped Name 9nature ant ay ear �� F- 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection [:1 Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U LL Fac li 's Phone. Month Day Year 18c.S gnaWre of Anemate Facility(or Generator) 4 Z h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O 1' 2. 3• 4. I I - ff:::] 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a th ay ear rinted y me nature 1 EPA Form 87 2 (Rev.3. 5) Previous editions are ob olete. ;!., , tor'_) ' I.IVY T OFSTh•1�flGP3 S1:ATt=(It-REQUIRED)