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SHIPPING 1.Generator to Number 2.Page i of 3.Emergency Response Phone 4.Shipment Tracking Number <br /> DOCUMENT CAL000427616 2 77577 412289980501- <br /> 5-Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Bath & body Works .1510 Bath & Body Warks#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> Generators Phone: 209472 STOCKTON CA 95207 STOCKTON CA 95207 <br /> 6.Transporter 1 ConVany Name U.S.EPA ID Number <br /> Steric cle Suecialty Waste Solutions Inc MNS000110924 <br /> U.S.FPA ID Number <br /> 7.Transporter 2 Company Name Q� „ d /��e // /���y ��� �� <br /> 8.Designated Facility Name and Site Address /21st Century EMN, LLC U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV B9408 <br /> Facili s Phfxle: 7755752760 <br /> 10.Containers �NVD'91830895338 <br /> otal 12.Unit9a 9b.U.S.DOT Descrow(i ciudurg Proper Shipping Name,Hazard Class,ID Number,and Packing Group(d any)) No. T ,y <br /> HM Type WtNol. <br /> s <br /> ooa <br /> 1-ConsumerElectronics for Recycling 1 CF 00010 P <br /> gQ <br /> r <br /> .s+ <br /> r <br /> r: <br /> ;;.rHandkV Instructions and AdrStionat Information 1. 111131(Consumer Electron ics for Recycl e) <br /> r <br /> TOt CC�1? 1C#Tlgt$1 treraby declare that the contents of this consignment are fully and accurately described above by per shipping e,.and are classified,packaged,marked and labeledlplacarded,and <br /> iq�kp tespeps»proper kotar toriransporl accord ng to applicable international and national governmental regulations. <br /> 'g"reMonth Day Yea <br /> 1'sr <br /> Printed/Typed{Jame SRC re on if of Limite <br /> oto <br /> t5 <br /> I LA <br /> a <br /> ❑Import to U.S. ❑E)port from U.S. Purl of entry/e <br /> T` rte( . re for Date leavin <br /> �:firat)spo[EeiRdcrioiyiedgmerd of Rece+pt at MaterialsAI <br /> i Printediryped Name Si ture Month Day Year <br /> a <br /> � p <br /> 4 Tragsporter 2 PrmjedlTyped Name S re Month Dx �f� <br /> ` v <br /> 17,Disc.gpertcy <br /> 17a bjsciePaiiy 1f1d1caGor Space ❑Qu <br /> antity ❑Type <br /> ❑Residue ❑Partial Rejection El Full Rejection <br /> Shipment TfackinNumber <br /> 17b.Alternate FaaTity(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> u( Facility's Phone: <br /> m 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z a�<r <br /> kwu <br /> , <br /> � 4 <br /> 18.Designated Facility Owner or Operator:Ceftificahon of receipt of materials covered by the shipping documnt except as noted in Item 17a <br /> Pdnted/Typ n <br /> Signal ur � Month Day Ye r <br /> `G i <br /> 169BLC-O(Rev 5-11) ESIGNATED FACILITYTO GENERATOR <br />