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r i 999.1 Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) "' ' Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000427616 1 18775772669 011386558 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Bath & Body Works 1510 Bath & Body Works#1510 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE Generator's Phone: STOCKTON, CA 95207STOCKTON, CA 95207 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Na U.S.EPA ID Number 8.Designated Facility Name and Site Ad ess5 e n ur y ! U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 hFacility's Phone:775575760 NVD980895338 9b.U.S.DOT Description(including Proper Shipping Name,Hazard class,ID Number, 10.Containers and Packing Group(f any)) 11Total 12Unit13.Waste Codes No. Type Quantity Wt.Nol.1LIN1993, Waste Fla..able liquids, n. o, s. (Ethyl 1DM 00027 P 331 D0011U002 0Alcohol, Acetone), 3, PG II, ERG#128 M 2. w CD I 3. 4. 14.Special Handling Instructions andAddilional Information am laa a 1 g U 1 5 i 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classed,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if i am a small quantity generator)is true. enerator's/Offeror's PdFted/Typed Name Signature SRCL rep 94 be h a l f 0 f Li In i t e ont ay ear j 04 20120u 16.International Shipments Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials � Transporter 1 Pdnted/Typed Name Signature 0 I �,•j' on ay Year N Jared Marcie 1 + 04+ 201201E Transporter2 Print d/Ty Na gnature Month Day Year ~ S l 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection 1 ❑Full Rejection Manifest 18b.Alternate Facility(or Generator) Reference Number: U.S.EPA ID Number 0 Q Facility's Phone: wF— 18c.Signature of Altemate Fli acity(or Generator) Q Month Day Year Z N19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) D 1' 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name MM99PM= EPA Form 8700-22(Rev.3-05) Previous editio s are obsolete.