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� !�II��!�III�II��IQ��IH ���ll�lllll��l�e <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11-Generator ID Number 2.Page 1 of 1 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000427516 1 8775772669 010788647 FL E <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> �1 Bath & Bodv Works 1510 Bath & Body Works#1511 <br /> 2+94729339 4950 PACIFIC AVE, WEBERSTQWN MALL/ SPACE 4950 PACIFIC AVE <br /> Generators Phone: STOCKTON CA 95207 STOCKTRN, CA 95`07 <br /> 1 6.Transporter 1 Company Name <br /> U.S.EPA ID Number <br /> Steric cle S ecialt Waste Solutions Inc MNS00mber 4 <br /> ` 7.Transporter 2 Company Name <br /> l\_ U.S.EPA 1D Number <br /> 8.Designated Facility Name and Site Address General Environmental Mgt, LLC <br /> U.S.EPA ID Number <br /> 11855 White Rock Road <br /> Facility's Phone: 9163 10980 <br /> Rancho Cordova, CA 95742 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10Containers <br /> HM and Packing Group(if any)) . 11.Total 12.Unit 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> Ix 1LotionRA hazardous waste, solid (Soaps, 1 CF 00019 P 331 <br /> _.._....__. <br /> ZF 1 <br /> 2. <br /> Non RCRA hazardous waste, liquid (Soaps, 1 DF 00087 P 331 <br /> Lotions), ' <br /> 3. <br /> I ; <br /> ( <br /> t i <br /> 4 { <br /> r <br /> 14.Special Handling Instructions and Additional Information <br /> Liquids) 1. 110903(State Regulated Solids) 2. 110902(State Regulated <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 international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify,that the waste minimization statement identified in 40 CFR 262.27(a)(if t am a large quantity generator or if I am a small uanti <br /> Generator erors Printe ) ()( q ty,generator)is We. <br /> yped ame rgna ure CL re ort ay ear <br /> 0 p be of Linite <br /> J�i 16.lnternafionalShip nts 20 7 <br /> ❑Import to U.S. ❑Export from U.S. Port f entry7exit: <br /> Z <br /> Transporter sinature for exports onl : <br /> Date leavin U.S.: <br /> 1J 17.TransporterA,cknowledgment of Receipt of Materials <br /> ransporter 1 PrintedlTyped Name <br /> aenolate ort ay ear <br /> Harper <br /> Z Transporter 2 Pnnte d/Typed Name renal r 1 20 7 <br /> Month ear <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space rr�� <br /> u Quantity u Type Residue ❑Partial Rejection <br /> 1 ❑Full Rejection <br /> 18b.Alternate Facility{or Generator) Manifest Reference Number: <br /> .r U.S.EPA ID Number <br /> V <br /> Q <br /> u- Facili 's Phone: <br /> 18c.SignaWre ofAltemate Facility(or Generator) <br /> Q Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> rUJ <br /> n u <br /> 3. 4. <br /> 20.Designated ty Owneror Operator:Ce tification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdnted(fyped Naameme Signature <br /> Month Day Year <br /> o A. / 1031171 <br /> EPA Form 0- C 8700- (R .3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED <br /> ..----_ —.___ .___ <br />