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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 9 ( P ) YP ) PP UNIFORM HAZARDOUS 2.Page 1 of 3.W77ff"sy hone 4.Manifest Tracking Number WASTE MANIFEST I 1 1 010788930 F L E 5.Generator's Name and Mailing Addr hs Generator's Site Address(if di dess) . ath & Body Works 1510 �are`��ian�aili�$�ry Works#15 10 80947293329 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE Generators Phone: STOCKTON, CA 95207 STOCKTON, CA 9507 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address ellSt Century EMN, LLE U.S.EPA ID Number 2095 Newlands Dr . East Fernley, NV 89408 Facility's Phone: 775575"E'760 NV D980895338 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. ce X1. UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 CF 00010 P 33� DOM U00 a Alcohol, Acetone), 3, PG II, ERG#128 - -� ---<-- tr W X2• UN1950, Waste Aerosols, [flammable, (each not 1 CF 00002 P 33� D001 exceeding_ 1 L capacity)] 2. 1, ERG#126 ----! --- ---- i i 3. j 4. i 14.Special Handling Instructions and Additional information 1. 110905(F l a m m a b 1 e Liquids) 2. 110904(Aerosols, Flammable) 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of[his consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl 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)(J I am a small quantity generator)is true. Generators/Offerors Printed bignature L rep beh f of Limite Month Day Year 11 21 201 j 16.International Shipm is ~ ❑Import to U.S. ❑Export from U.S. Po of entry/exit: Z Transporter sinature for ex ortsonl : Date leaving U.S.: w17.Transporter Acknowledgment of Receipt of Materials � Transporter 1 PrintedfTyped Name Signature Month ay Year a Johnny Harper I I 19 2132 2017 Z Transporter 2 Printed/Typed Name Signature Month Day I Year U; 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity Type❑ p ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U Q Facilitys Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) 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 Printedlryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous e I ons are obsolete. DESIGNAT D CILITY TO DESTINATION STATE(IF REQUIRED) ❑7th:h_=4 1'-u,. -. ^ ithF_'7005 n,.tthr'.!i o o i M ri i11•_D117 Cr,1 __,i i-7