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Please-int or type.(Form desi ned for use on elite(1 2-pitch)typewriter.) " pp Form A 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 r , ,27r- F q77 '- �--F c 0085537 3 9 F L E 5.Generators Name and Mailing Address Generator's Site Address(if di erent than mailing address) Bath & Body Works#1510 20947t9339 4950 PACIFIC AVE, WEBERSTCWN MALLi SPACE 4950 PACIFIC AVE Generators Phone: STC T 5j,' ST 9 521217 6.Transporter 1 Company Name U.S.1 PAID Number Steric 'cle Specialty Waste Solut ons Inc MNS00011092- 7.Transporter 2 Company Name U.S.EPA ID Nu mbt }, Fti J J� 8.Designated Facility Name and Site Address General Environmental Mot, LLC `EPA ID Number 11855 White Rock Road Rancho Cordova, CA 95742- Facititys Phone: 91F,3510980 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 o X 1LIN1993, .Waste Flammable liquids,... n. o. s. (Ethyl 1 CF 00008 P 331 D001 U002 0 Alcohol, Acetone), 3, PG II, ERG#12-8 Z: on RCRA haz-ardous waste, solid (Soaps, I CF 00008 P 331 0 Lotions), orf RCRA hazardous waste, liquid (Soaps, 1 CFS 00022 P 331 Loti.ans); , 4. 14.Special Handling Instructions and Additional Information 1, 110905(F l a m n a b l e Liquids) 2. 110903(Sta t e R egulated Sa l i d s). 3. 110:902(State...R.egulated.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 terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(it f am a large quantity generator)or(b)(if t am a small quantity generator)is true. Generaln-ro'A s riMecirl" d Nae gna ur on ay Year j 16.International Shipments ❑ ,4; 06 30 ,201. ZImport to U.S. ❑Export from U.S. Port of entry/exit Transporter signature for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PdntedlTyped Name ignature onth Day Year a- rJsI:dY:4.,Md1"t7,hQZ,. . _. ,._ ;,•..;. '�'' , ;, "." a.�nl:;. tr' ,::31�:.:L�1 ,:.•. 4 Transpolar 2 Printed/Typed Name .ig Month Year H 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑ Type El Residue ❑Partial Rejection ❑Full Rejection 18b.Atemate Facility(or Generator) Manifest Reference Number. J U.S.EPA ID Number U a 0 Facili s Phone: LLj 18c.Signature ofAltemate Facility(a Generator) Month Day Year Q Z LU 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) D 1 2. 3. 4. V-441 4-14 20.Desig ated cility,Owner Operator:Certification of receipt rdous materials co ered by the manifest a ept as noted in Item i Pr yped Na e Signatur n Day Ye EPA Form 8790-22(Rev.3-05) Previous editions are obsolete. ES1 iATED FACILITY TO DE '1N TION STA E IF QUdCtE j Fi7tAlA—,'r 1 civ? f'!�J9�?7A 411Ar=,7A9�i n4njgpig! r. M IDr1tAF..�th17 Gflt7tc.,�Dt17