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111111111111111 <br /> Form Approved.OMB No.2050-0039 <br /> Plebse pri€tt or type.(Form designed for use on elite(12-pitch)typewriter.) pp <br /> UNIFORM HAZARDOUS If tiWWC2' 616 7,e 1 of 3.ggp?`rvy�F,SP&&Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST tGS//rrllrr/i�cDDO077 010076748 FLE <br /> 5.Generator's Name and Mailing AddriridGenerator's Site Address(if` a ha a a dres Jth & Body Works 1510 y <br /> orks#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> Generator's Phone: <br /> STOCKTON, CA 95207 STOCKTON, CA 9507 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name ad Site n1St ant ury , LLC U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone: 7755752760 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 X/Vol. <br /> X1 UN1950, Waste Aerosols, Cflassable, (each not 1 CF 0000b P 3311; D001• <br /> of exceeding 1 L capacity)] 2. 1, ERG#126 <br /> 2.LAJ <br /> i <br /> i <br /> 3. j <br /> { <br /> 4. <br /> �l <br /> t <br /> 14.Special Handling Instructions and Additional Information 7 1-13111111 table) <br /> 15. GENERATOR'SIOFFEROR'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 in rpgtj aI and national govemmental regulations.If export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgm 4ttgg set({e p on behalf o f L i s i t e <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(if I am a small quantity generator)is true. �y <br /> Generator'slOfferor's Printed/Typed Name Signature _ ° 1 C/+ Irl <br /> 1 ntemational Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> F— <br /> Z Trans ortersi nature for exports onl : Date leaving U.S.: <br /> LU iY 17.Transporter Acknowledgment of Receipt of Materials <br /> li— Transporter 1 Printedrryped Name Signature <br /> MonthDay <br /> 24 20r1 <br /> oo o Kristopher Alsanza I j 1 <br /> U) T po ter 2 Pr nted ed Name ignatu Month Da Year <br /> taid— <br /> 1B.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 1Bb.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facilit's Phone. Month Day Year <br /> Ulu! <br /> 18c.Signature of Altemate Facility(or Generator) <br /> Q <br /> z <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 1 2. 3. J4. <br /> O ' <br /> 20.Designated Facility Owner or Operator: ertification of receipt of hazardous mater als coveted by the man'rfesl except as noted in Item 1 Ba Month Day Year <br /> PrintedrX0-22 <br /> Signature <br /> r <br /> EPAForm 8v.3-05) reviouseditions are obsolete. J <br /> DESIGNATED FACIADESTINATION STATE(IF REQUIRED) <br /> 8700-22 12v3 C8293378 S41067895 041026237 M PDO12418 SDO12418 <br />