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II�� fl�(I ��If((((I(flfllf�lf�l�I Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1,Generator 10 Number 2.Page 1 of 1 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000427616 1 8775772669 .- 0085 5 3806 F L E 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) Bath & Body Works#1510 20947229339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE Generators Phone: STOCKTON, CA 95207 STOCKTON, CA 95207 6.Transporter i Company Name U.S.EPA 10 Number Stericycle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address General Environmental Mgt, LLC U.S.EVIND Number � 11855 White Rock Road Rancho Cordova, CA 95742 Facility's Phone: 9163510980 CAD980884183 . 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 tz X 1UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 CF 00020 P 33 DiOi ,1100 a Alcohol, Acetone), 3, PG II, ERG#128 W 2Non RCRA hazardous waste, solid (Soaps, 1 CF 00026 P _ 331' Lotions), 3Nan RCRA hazardous waste, liquid (Soaps, 1 DF 00061 P 33 Lotions), 4. 14.Special Handling Instructions and Additional Information 1. 110905(Flansable Liquids). 2.110903(State:.Regulated .Solids) :-. 3-41,0902.(5.t.at.e:{Regia latod,: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 intemational and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms 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, enpr, ors/O eror's Print ype Name ;51n r on ay ear � pments 16.International Shi ZImport to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature % Is.idna,,,M a►r.`t..i.n ez..; r.. on ay ear moi' = .. Transporter 2 Printedliyped tdameignatur2 n ay year lir F- 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Reference Number.e ate Facility(or Generator) U.S.EPA to Number U Q Facility's Phone: LU 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) O1 2. Imanffest �L4. 20.Designated Facility ner or Operator.Certification of receipt of hazardous materials covered by thexcept as noted in Item 18a Printed/Typed Name ture Mrx>� pay Year EPA Form 8700-22(Rev.3-05) Pr vious editions are obsolete. ' l♦ DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) 07"ACA—O'm t'J..? C`tl•Z67?7n nttrar�fnnr --.... , ._ _.