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F <br /> tiS-�'7>'fn2 fa W. (Form d for rf5e an elite(1z-pftrn)tps,c�wioer) «m Approved OMB No 2050-o639 <br /> E� UNIFOFM FLAL4RUOUS I 1 Gaga-17 Nurnber i Pane 1 of 3 Emergrty Rssponsa Phone 4.91an9est Tratldng Number <br /> 1 WAM 11AN1FEST I LAL000427616 1 8775772669 011387076 F L E <br /> �s Gaper V.,Nw*andh,3liog.Addmw Cerer3ECY3 (eAddreGsft&*fentAt�lita addre=5 <br /> ( Bath 8 Body Works 1511 Bath & Body Works#1510 <br /> E.0'347293:39 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE, <br /> 3-r!'-ne STOCKTON, CA 95L.07 STOCKTON, CA 95�W <br /> Corn;, Name US EPA 16 kcoer <br /> 1 Stericycle Specialty Waste Solutions Inc MN5000110924 <br /> `-x4cv',a 2 Cwipany Pierre <br /> t U S F MID Ntmofter <br /> Worldwide Recovery Systens CAR02017542c: <br /> !°:,=graswFadity%nexxSmeAddreas Yuma Yes, LLC US EPA IDNixrber <br /> ? ; 3 <br /> 2730 L. 13th Street <br /> Yuma, AZ 85365 <br /> Faiity'sPhnne 9c'I�Fs4s;'.f39s€3 AZR0005159C 4 <br /> ya 95 U S DoT Descmaw(Ir iJdrg From Shipping tarn¢.Hazard cksr,®Nfrrrber, ".t)cortta pars <br /> Ht! OV, Gform Ie any) F, fatal 12 6uni13'A%S*rode,. <br /> a^a Pack' No Type Olimlity 'A'1 P,bi <br /> Non HCHA hazarclous waste, liquid (Soaps, 1 DF 011,:; P 3;,1 r <br /> oLotions), ' <br /> LU <br /> x <br /> W t <br /> f <br /> 3 � <br /> S <br /> 1. 110902(State Regulated Liquids) <br /> 15 GENERATOR'SIOFFEROR'S CERTFr-AT1oN; I otrt.'by oxia a bete m tenft of hG axrsWTieft are hdy and aaarab*desatbed abo,o by Tia=W shippe,rromo.and are dawfied,tracaaged. <br /> marked and t%bfid,and are it ad respects a xam oxidigm Er tra+spoc acoydmg't)appficahle vtesna5ohy and of te <br /> tO I Lesp <br /> rr t.o � taaom If at st i ers and I am re Pr <br /> Experts✓. fftfy fft'et he mrCetts of osis mrmgurert c6rtfarm the tam the etaaCt end Y <br /> EPAPthtav#edgrrent qQ CCestsrl <br /> 1 cert,ji diat the vasre minmlmcm siatxnerd iderfied mar)CFR M Via)91 art a targe a+w*gerterakr)cr lb;(i 1 am a snal gi;andty genesaW is true <br /> oro C yam`'' y ¢ ' � r p on behalt or !_faits <br /> 0 2 201 8 <br /> J �tdma'ttofal Shifxrents �—, t� <br /> Export from 11 S Port a entrytetra <br /> z Tram rW xe'kx ew Ttt rater� Dae <br /> 17'ran spoor AdmaMabgnerrr d d Mateiats <br /> LU <br /> _ <br /> Trarapwter 1 Prntedr yprsrt%(m SmartLfortri ear <br /> a Kristopher Almanza - --" <br /> to 2 20 $ <br /> ZTrarworfar 7?MV.Ar7 VW Natlrc UJIV <br /> OOOCCC Cay tear <br /> roLw ✓. � <br /> 1B Orotrepartcy <br /> 18a Dsrenry lyd c3tw Spaca J 0xtity [IT" ParSal 1 FJ Re+j r <br /> Mage st Refesenrr.N AJ� snbrr. <br /> 18b naW Fac k(or Ger4r4ofr U 5 EPA 1)Number <br /> J <br /> v <br /> LL FaditYs Ptt4ne, <br /> W 18c SgrlaLf-of Aaemate Facilty(or t;ertaraSx} 6farrm Days y'aar <br /> 4 <br /> z <br /> 19 H=*us WaEle Repo✓,hf8rtagCmdtt hMadxd Codas(i a,cedes for,=(bus wMtL nnt7 ent.d spra7,and wyd og syyerm <br /> d LLJ1 2 3 4 <br /> 2U Desgnwee Fadity 0*a cr Cpaabr Ca tart of inept of r'azardor a mater els WAW by dre mares except ss rOf.d in Item 18a <br /> ?rt ped ams11 yjCk 74 V J Ck.VP1-1 I'MEi I I_ ,!wtCi Darr 1'{:3r <br /> EPA Form a7f0-Z2{Rev.3-05) Premous wins are obsc�ae, l <br /> sivilnt"i i)r.tCEE!T � i>efiT:'� ,:lt}�;:iiATi fi Rz��(11R1"D) <br />