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! II IF <br /> Please pr;nt or type.{Form desiar!ed for use on elite(ig-pitch}typer'rlter.j <br /> UNIFORM HAZARDOUS t Gene ator ID Number 2.P„ac 1 of 3.Emeryc•c n^.es�ense phone Form Approved.011913 No.2050.0039 <br /> WASTE MANII:EST 1 r 4.Manifest Tracking Number <br /> 5 Generala!'s Nerra and hdaitirg.Adiress <br /> 011392669 FLE <br /> Ge eralcrs Si'2 .^;tees(;t ciFrerenl than ma it g addrzss) <br /> Bath &Bath � Body Works 1510 <br /> '094729339 4950 PACIFIC AVE, WEBERSTOWN h1ALt_l SPACE �a=350 PABa-th C IFICody `�AVEs�1�10 <br /> Gentratols Phone: STgCN T{J CR r�Ji=YJ f <br /> 6, ransponer 1 CUnrpany a:ne iT'1) '1:TON CA t3Sc 17 <br /> U 5.ESA T N'.nber <br /> 7.Transporter 2 Company h.a ne r <br /> Worldwide Recover Systems <br /> U.S.EpAlONarfjer <br /> B.Dastgna ad Faeitity Name a^d Sita Addresp Lima Yes, LLC AR000175422 <br /> U.5 EFA 10 NuNumber <br /> 2730 E. 13th Street <br /> Yuma, AZ 853155 <br /> Facitsty's Pho. 'n <br /> 9a• 99.U S 00T Description(Including Proper S n Noma,i azarc Crass,tD r wrl? er. Cc- c r ' <br /> HM and Packing Group(f any)} �PP�9 ,. <br /> <�9^13`5 1 i TC?c! 12. <br /> Ura <br /> 1, <br /> ;NU. Type Quantity 161. 1. :3 Was-te CSdes <br /> JX <br /> on RCRA hazardous waste, liquid (Soaps, F 0259 Fr 331 <br /> otions), <br /> w <br /> W 2 <br /> 0 <br /> 14.S ai Hardy lrtstnrctions and Addit:cnai Information <br /> I. 110902(State Regulated Liglaidsi <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare drat the contents of!his consigr:m-,;i ere fully and actliWely des t>Ed above 5y rho proper shiixing na r:e.and a-e classified.packaged, <br /> marked and certify <br /> that <br /> the cont,and are in a8 respects in proper condition far tran ri a.^xrding to a(g;iratte rser^a{;gnat arta Heti naa <br /> governmental a Prdafions.If export shipment and t am me Primary <br /> Exporter,f cart ry that thn contents of h s cons gnment cartann:o the terms df the site teed Epggcttruycc edgmerft W Ccrs2ni. <br /> !cer]"1y that the waste mirtimiZZIII Statement identified in dC CFR 262.2T(a)(f I art a;urge guar,`-ger (i:;ar:,a smut:raanlii nater r`s true. <br /> ( Generator's' , tors Printed(fyxd Name r y generator), <br /> ;;re <br /> 1 SR e o b fof L' e... . <br /> 16.internat�onat Shipmeels _ 3111 t <br /> +:.,.f ...,. <br /> -- Trans orfersiana;ue iUrax Urtsonl�i <br /> 17.Tru tspoderAcknowiedgrtent of Receipt <br /> Transporter 1 PrintedrTyped Name <br /> p .,gnature <br /> n � ont ay ear <br /> t��t z a xlna2rre <br /> r 0 t ay <br /> 78.D%crocanry � i(� <br /> 18a.05crepancy Indication Srace �— <br /> t-_j OLantity <br /> Par a, <br /> t Full Rejer:.or: <br /> 18b.Alternate Fa lily <br /> (v U.S.EP.A 1G tJumb�! <br /> if <br /> � <br /> �- F 'ivsPlsone: <br /> Lij <br /> 1&.SInature pFALematz Facility;or Generator) <br /> Q <br /> h+1or:;h Day Year <br /> 19 Nazd r us::taste iidpart"lar en n <br /> .,. �. 3 is $•;�� r•-:125(t r <br /> uJ t.-i t.d�., Cvde5`r <br /> 2G.Dasigsale�t=aciit?C'N:ner cr Oheratcr.CerttfitaliUn cF rere;rpt cr Helot us r.;c ,,s •m�e^cl tnr•a:ar.;fs,..lee : reit <br /> I Printed T} Nam <br /> f gr+zt€;re <br /> [ I ktinth Day Year <br /> LGn Form 87,,;-22(Rev.3.05; Previous—.u; are obsolete. t t <br />