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Please print or e. Form designed for use on elite 12- itch typewriter.) "" "`"` "' Form Approved.OMB No.2050-0039 P YP ( 9 ( 2-pitch)tYP ) PP UNIFORM HAZARDOUS 1.Generator ID Number 2.Page I of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000427616 1 8775772669 1 010176441 F L E 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) Bath & Body Works#1510 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE Generator's Phone: STOCKTON CA 95207 STOCKTON CA 95207 6.Transporter 1 Company Name U.S.EPA ID Number Solutions 7 7.Transporter Com anyNa U.S.EP ID Number �!/�� c/ T�l�l1 8.Designated Facility Name and Site Address -2 , U.S.EPA IID ANumber �- ri., 'fi AnnL D+_� � ,Jt lJ"•"� /7/VU /0 U��" '3';� 77T-971r-2160 , eFt 0',tf ,I'w�a at br. Facility's Phone: A t?71/10 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 Wt.Nol. 13.Waste Codes X 1.UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 00033 P A D001'U002 Alcohol, Acetone), 3, PG II, ERG#128 - 4 w 1 X 2UN1950, Waste Aerosols, [flammable, (each not 1 CF 00005 P 33i D001( exceeding 1 L capacity)] 2, 1, ERG#126 t � 3Non RCRA hazardous waste, liquid (Soaps, 1 DF 00075 P 331 Lotions), { 4Non RCRA hazardous waste, solid (Soaps, 1 CF 00009 P 33I Lotions), , 14.Special Handling Instructions and Additional Information 1. 110905(Flammable Liquids) 2. 110904(Aerosols, Flammable) 3. 110902(State Regulated Liquids) 4. 110903(State Regulated Solids) 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.It export shipment and I am the Primary Exporter,l certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 1 certify that the waste minimization statement ide tified in 40 CFR 262.27(a)(N I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generaluo!w ror's PrintedfType Na`I�Iignature Monthay Year hJ n SRCL rep on behalf of Lieite 1 091 1 Al J 16.Intern ional Shipm nts j..-, ❑Imp to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: W 17.TransporterAcknowledgment of Receipt of Materials LLJ� Transporter 1 Printed/Typed Name signature on ay Year O a Z Transpo er Ott. ype ame Sig nature Mon ;�w 1160-N7 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue Partial Rejection Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q Facili 's Phone: UA 18c.Signature of Altemate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. t i l 2. I 3. t� 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 I^ , I r Signature Month Day Year YYl r cam, lj/1 t l�L.�/Y� /0 IY l EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. D1111V, D FACILITY TO DESTINATION STATE(IF REQUIRED) 8700-22_12v3 C8293378 541067895 040924658 M PDO91317 SDO91317