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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number <br /> WASTE MANIFEST CAL000427616 1 8776772669 010 90137 F L E <br /> 5.Generator's Name and Mailing AddrTs Generator's Site Address(if different than mailing address) <br /> Bath & Body Works#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> Generator's Phone: STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc IMNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address en erai Enivironsentalg U.S.EPA ID Number <br /> 11855 White Rock Road AI's <br /> Rancho Cordova, CA 95742 f&L �-3_ _ <br /> T`j <br /> Facility's Phone:9163510980 ICAD96 884163 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No, Type Quantity Wt.Nol. <br /> Waste Flammable liquids, n. o. s. yl 1 CF 00006 P 331 1I)l P002 <br /> o Alcohol, Acetone), 3, PG II, ER6#128 <br /> i <br /> Z Non RCRA hazardous waste, liquid (Soaps, 1 DF 00060 P 331 ; I <br /> Lotions), <br /> t <br /> 3. <br /> 1 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information 1. 110905(Flaosable Liquids) 2. 110902(State Regulated Liquid's) <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 labelediplacarded.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 /> 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 quantitynerator)is true. <br /> Genera to s! rs Pri led/T ped Name I Signar ont ay ear <br /> j 16.Intematia ipmen s <br /> 07 26 17 <br /> H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Z <br /> Transporter sinature for exports onl : Date leaving U.S.: <br /> L 17.Transporter Acknowledgment of Receipt of Materials <br /> t— Transporter 1 Printed/Typed Name Signature <br /> 9 Month Day ear <br /> 0a Jared Marciel I 107 126 k@17 <br /> Transporter 2 Printed/Typed Name7C646..4Signature Month Day Year <br /> r ,J /7 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity Type 1 ❑Full Rejection <br /> ❑ ❑Residue Partial Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> 1Js � � cIIV1rOMtin mMkge <br /> me' O <br /> 0101 LL-C- <br /> � , 2ociS Nfwl(LII��QDr. ttV q� $gS338 <br /> aC-775) r Iv <br /> LL <br /> Facility's Phone: 7 6 V <br /> W 18c.Signature of Altemate Faci dY(or Generat Month Day Year <br /> a v ' <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1. 2� � 3. <br /> L <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous atenals covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />