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Please print or type.(Form designed for use an elide(12-pitch)typerrnter.) Form Approved OMB Nb.205MD39 <br /> uwomw HAZARDOUS 1 Generalor ID Nur ber 2 Pagel of 3 Ema?%rcy Response Phoma ' <br /> Yv16M386909 <br /> Number <br /> WASTE MANIA CAL000427616 1 8775772669 F L E <br /> 5 Generabrg Nacre and Mwliru;Address Generators Sft PAdtass{if dmitrem man maieig atrea} <br /> Bath & Body Works 1510 Bath & Body Works#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> ConerakYs Ptrone: 52 <br /> STOCKTON, CA 907 STOCKTON, CA 952*7 <br /> rarrsPortet 1 Name U Er'Atp�m, <br /> ericycle Specialty Waste Solutions Inc 11r0924 <br /> 7 1r3nsPQr er 2 Q01Wry N3M US EPA 1D Nianbsr <br /> 7 <br /> a Desigraied acfttykameare�dress <br /> Yuma Yes, LLC US EPA IDNunoer <br /> 2730 E. 13th Street <br /> Yuma, AZ $5365 <br /> Fao7dy's Ptaxa <br /> 93 b U S DOT Deswption{irdtdng Pro Shipping Name,Hazard Class,ID Nxter, 10 Cantairras 11 Total 12 Und 3 V�ste GxJrt <br /> NSI am Packry CAW R�y11 No Type Ouanrky wt nai <br /> o tNon RCRA hazardous waste, liquid (Soaps, 1 DF 00092 P 33-i <br /> Lotions), <br /> Z 2 � 1 <br /> W <br /> i <br /> i <br /> r <br /> s <br /> i <br /> 4 <br /> i <br /> i <br /> r r <br /> 14 SpecJ Ftrdng Imravc�tam ardAddDonai IrbrrnAm <br /> 1. 110 (State Regulated Liquids) <br /> 15 GE3ERATORWIFFEROIFS CERTIFICATION: I hammy decliart3 hat rhe ownErrm of dis wr*weirtt are f jt q aro accurately Oe4-nbtd abevr.t7y the proper 5hpping nano,and are kassfr ,packaged <br /> maked and Iabefed/pl arded,and are in ae respec'ks in pwpa oaaiit w kv traespartacwra ng b appfrabie inorckrtel and natioft po mentai rog¢Agms ff axpui siert and lam the Pri ary <br /> Exrortor.I on:%Cat Or mnlmts or hs consignment mx to ft mums af to a&Khad EPA Admoile 7vrent at Consent <br /> I petUfy hat Cte x<rsle mni�aepn statement iderMr(led'h 40 CFfi 252 27(a1{i 1 am a farg6 G qty gener�j Q(hj{rf I an a$nal qua �prye <br /> 5 Prvwdi7ypedep b I of Limite — <br /> {S(�A �M 021 el-71 201 <br /> 16 Snipi <br /> 11 Irport to U S ❑Export!''U S of it <br /> ? <br /> Trangiortsr sklialureU Exports only). <br /> DatE U.5_ <br /> w 17 Tmr>spOrlcrAdTow*grrxnidPomptofMawlais <br /> a- Tmmpor4er 1 Nrftdqyped Nam S+gtrall- Wrw Day <br /> a <br /> Kristopher Almanza <br /> 'T' <br /> 18 t�screyarrcy <br /> 1aa.Dwepancy lndcarw soa C Ty, CJ Fb,- x L_J Partial R*-'b n U Fedi Boris <br /> Mw&stRekmnceMjfflbef. <br /> 18b Attrnate Facity fa Gener=) US EPA ID Nurbw <br /> J <br /> V <br /> a <br /> � Fad s F1»rte. <br /> F18c S grakue sir Aiertete Faddy(a Generabr) Mmh Day Yex <br /> Q <br /> 19 Fb4viJora Waste Report l t mood Codes(i e.wiles lw NXWOxs wasae tragneK.*Posal,of mcy*m systems) <br /> n t 2 3 a <br /> 0kL4t <br /> 20 Designated Faciity Oorw or Operator CvWcFkc cf receipt of h=m6m nNerials anered by the froom except as ndad in bm 19a <br /> yv�xa� S+gnalre Mmlh Day year <br /> ) <br /> EPA Form 870422(Rev 3-06) Previous edtiau are obsolete. 01 SiGNATT'D E AC1l 17Y TO OF ST INATfON STATE(1E REM ED) <br />