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tl/tC4tr-��,1r=V; I;bL7 /t3 S41ral]/t7yJ U410'7/1'i�1Cr g��uryl*nnt'' �IyIN�n PU)�1III1pppII101/ 5U111N1/ � �INHINII/II �� I�IIII Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST _ 008629419 FLE 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) Bath & Body Works 1510 Bath & Body Works#1510 094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE Generators Phone: 6.Transporter 1 Company Name PA umber Steric cle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address 21st Ce t ur y EMN, LL6 U.S.EPA ID Number 2095 Newlands Dr. East Facility's Phone: Fernley, NV 89408 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity W1.Ivol. 13.Waste Codes 1. t o X UN1993, Waste Flammable liquids, n, o. s. (Ethyl 1 DM 00059 P Alcohol, Acetone), 3, PG II, ERG#128 ru X 2. Lu C7 r 3. I I i 4. 14.Special Handling Instructions and Additional Information 1. 110905(Flammable Liquids) 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, 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantitya or(b)(if I am a small quantity generator)is true. Ge s/Offerors PrintedrTyped Name 61gnature on ay Year {�► t yAnq p44\fAg, e J 16.International Shipments z ❑Import to U.S. ❑Export from U.S. Port Ofentry it: Transporter signature for exports only): Date leaving U.S.: w17.TransporterAcknowledgment of Receipt of Materials OTransporter 1 Printed/Typed Name g Monthay ear a1 1 4rn Transporter 2rinted yped Name Signature Mon111- Day ear 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type yp ❑Residue E]Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q LL Facility's Phone: w 18c.Signature of Altemate Facility(or Generator) Month Day Year Q z y 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ 1 #-( V/ 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 Printed/Typed Name / / 7 Signature Month Da Year C--4 112- 1 EPA Form 8700-22(Rev.3-05)'Previous editions are obsolete. DESIGPeAT�Q FACjLI DES;jNATEG i STATE(IF RE': YRED)