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039 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) -"" Form Approved.OMB No.2050-0 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page Tof 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST I CAL000427616 1 8775772669 010868395 F L E <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Bath & Body Works 1510 Path & Body Works#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> Generator's Phone: STOCKTON CA 95207 STOCKTON CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Compa;y Na U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Ailress d1st L;entury EI LILL U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone: 77557522760 NVD980895338 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> l.timl s , n. a. s. y 36_ 2 <br /> o Alcohol, Acetone), 3, PG II, ERG#128 <br /> � I <br /> w X 2UN1950, Waste Aerosols, [flammable, (each not 1 CF 00002 P 331, D001 <br /> exceeding 1 L capacity)] 2. 1. ERG#126 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1. 110905(Flaamable Liquids) 2. 110904(Aerosols, Flammable) <br /> 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 classified,packaged, <br /> marked and labeled/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 Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or )(if I am a small quantity generator)is true. <br /> Generator's/Offerors Printed/Typ Name g ont a ear <br /> Signature CL re half of Liatite y <br /> 041 03 201 <br /> _1 116.International Shi ents ❑ ❑Export from U.S. rt of entry/exit:_ <br /> Import to U.S. p <br /> Z <br /> Transporter signature for exports only): Date leaving U.S.: <br /> IY 17.Transporter Acknowledgment of Receipt of Materials <br /> ear <br /> tiTransporter 1 PrintedfTyped Name igMont ay <br /> iY nature <br /> no Johnny Harper 1 041 031201 <br /> CD <br /> Transporter 2 Printedffy Na Signatur Month Day Yeeaaarr <br /> f- Q <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U S.EPA ID Number <br /> J <br /> U <br /> Q <br /> tL Facili 's Phone: <br /> W <br /> 182.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e. codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1' 2. 3. 14. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedffyped Name Signatur Mo th Day Y <br /> EPA Form B700-22(Rev.3-05) Previous editions are obsolete. D SISNATE CILI Y TO DES INATION STATE(IF REQUIRED) <br /> 8700-2212v3 C8293378 541067895 041077442 M PD040318 SD040318 <br />