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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 11.Generator ID Number 2.Page i of 13.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000427616 1 8775772669 010788648 F L E 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) Bath & Body Works 1510 Bath & Body Works#1510 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE Generators Phone: STOCKTON, CA 95207 STOCKTON, CA 95207 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions Inc MNS000110924 7.Trans iter 2 Co-M pany.Nanjg U.S.EPA ID Number 8.Designated Facility Name and Site Addrits 21St Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facilitys Phone: 7755752760 NVD980895338 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)) 13.Waste Codes No. Type Quantity Wt.Nol. X1 UN1993, Waste Flammable liquids, n.o. s. (Ethyl 1 CF 00011 P 33} D001 U0@ Alcohol, Acetone), 3, PG II, ERG#128 - - -- -- w 2. XUN1950, Waste Aerosols, [flammable, (each not 1 CF 1010001 P 33, D001 exceeding 1 L capacity)] 2. 1, ERG#126 -- s--- -` --- - I 3. 4. c i f 14.Special Handling Instructions and Additional Information 1. 110905(Flamnable Liquids) 2. 110904(Aerosols, Flammable) 15. GENERATOR'S/OFFEROR'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 Bre contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certity that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or b)(if I am a small quantity generator)is true. Generator's/OfferorsPrinted/lyp edN me ignature RCL re n behalf of Limite Tont ay Year -P0*Pwv l —1 14 24 2017 J 16.International Shipm is Z ❑import to U.S. ❑Export from U.S Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name ignaiure Month Day Year a Johnny Harper1 114 24 2017 Transporter 2 Printedffyped Nanif Signa r Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space I ❑Full Rejection Quantity ❑Type ❑Residue ❑Partial Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J U Q Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year F- Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ 0 1' I'r`, /(�-, 2 3. 4. �r 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 f,J � Signature Month Day Year �,ay�1 R L✓rU '`!' '�iLtid I/ 171 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REc:?UIRED) A700-22 1?tr3 C8293378 541067895 040961707 M PD102617 SD102617