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Please print I�'�IH��'►� ���I� ��� f�11 �� <br /> print or type.(Form designed for use on elite(92-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> 41.Genera Number <br /> UNIFORM HAZARDOUS 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000427616 1 93775770- '_.' 010788848 FL E <br /> 5.Generators Name and Mailing Address <br /> Bath & Body Works 1510 Generators Site Address(if different than mailing address) <br /> Rath & Body Wor*s#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> Generators Phone.. STOCKTON, CA 95207 STOC)tTON,, CA 9581?17 <br /> 6.Tmnsporter1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inch1tdS4)Ih0i1-32j4 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address benerai Environmen dI Myt r LLC U.S.EPA ID Number <br /> 11855 White Rock Road <br /> Rancho Cordova, CA 9574 <br /> Facility's Phone: 9163510980 CAD980884183 <br /> ga_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.ContaiMDF <br /> 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Quantity Wt.1Vo1. 13.Waste Codes <br /> cc 1- Non RCRA hazardous waste, solid (Soaps, 2 X10178 P 33 <br /> Lotions), r <br /> UJ 2. Non RCRA hazardous waste, liquid (Soaps. 1 DF 10159 P 33 <br /> Lotions), <br /> 3. <br /> - <br /> 4. <br /> 1 <br /> f <br /> I <br /> It <br /> 14.Special Handling Instructions and Additional Information 1. 110903(State Regulated Solids) 2. 110902(State Regulated <br /> Liquids) - <br /> 15. GENERATOR'S10FFEROR'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 propercondition for transport according to applicable international and national governmental regulations.If export shipment and I a n the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) I am a small quantity generator)is true. <br /> Gene ators! eror s Printed/Typed N Signature <br /> rep n behalf 1101:: L i nli.t o on ay ear <br /> 1. <br /> 16.International Shipme 0 20 7 <br /> F- ❑Import to U.S. ❑Export from U.S. Jot entry/exit: <br /> Z Trans orter s nature for exports only): <br /> Date leaving U.S.: <br /> W17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printedfiyped Name ignature Ont ay ear <br /> IL Johnny Harper I 14 04 2,017 <br /> ZTransporter Printedllyped Name Signature Month Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> � 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> U.S.EPA 1D Number <br /> U <br /> Q <br /> Facili 's Phone: <br /> W18c.Signature of Alternate Facility(or Generator) <br /> Q Month Day Year <br /> z <br /> w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 <br /> f 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pri dlfyped Name Suture <br /> Month Day Year <br /> p <br /> r <br /> EPA Form 8700-2 Rev. 05) Previous editions are obsolete. t.ESIGNAI ED rACILITY TO DESTINATION STATE(IF REQUIRED) <br /> - <br />