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Please print or type.(Farm 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.Erne gency Response Phone 4.ManifestTracid Number WASTE MANIFEST CALM427616 1 8775772669 010�8 5 5 3 4 F L E 5.Generator's 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 . Stericycle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number I r Ift 39Z 133 8.Designated Facility Name and Site Add n 41 r , U.S.EPA ID Number '--.:= -�d�i{449R oc a„ f}Cw+�wa. 1NGL AIV�/�'U�53� -Sr 26 e p, Facility's Phone: /VY ?F 4' p tT-' 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,0 Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. o X 4JN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 CF 00011 P 331 DOOlIU002 Alcohol, Acetone), 3, P6 II, ERG#128 w Z �lon RCRA hazardous waste, solid (Soaps, 1 CF 00011 P 331 + 0 Lotions), j Non RCRA hazardous waste, liquid (Soaps, 1 DF 00074 R 331 Lotions), f 4. 14.Special Handling Instructions and Additional Information 1. 110905(Flammable Liquids) 2. 110903(State Regulated Solids) 3.110902(Stat,e Regulated 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 terns of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offerofs Pnntedryped Name Sign reMonth Uay Year SI�nn UJA 1 16.InterWonal Shipments F ❑Import to U.S. ❑Export from U.S. Part of entry/exit: Z Transporter signature for exports only): Date leaving U.S.: IX W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature ort ay Year a Isidro Martinez@81 262@1 U) Transporter 2 Printed(fyped Nam Month Day Year All 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑ResiduePartial Rejection l ❑Full Rejection ❑ Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q w Facili 's Phone: ,y j 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLI Cl 1� 1 2 � 4 3 ' 1 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Itein 1ka Printed/Typed Name r Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) .,. 871211101=22 42µ3 08293378 -_S41067895_. 040915609 M DMAPP. 7 .. cniataac 17