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Please print or ER I• Form Approved.OMB No.2175€1-0039 <br /> UNIFORM HAXAFiIFWS 1.Generator ID Number 2.Page i of 3.Emergency Response Phone racking Number <br /> WASTE MANIFEST ICAL0004276115 1 1(877) 577--2669 014905174 F L E <br /> 5.Ge€raralot s Name end M�thg Tl: [ y <br /> Terrell Geoeralors Stas Address(if ditant iffan malting aftess) <br /> Bath & Body Works 1510 Hath & Body Works#151O <br /> 12094729339 2 Limited Parkway 4950 PACIFIC AVE <br /> Genaratar%Phone-. Columbus CO 43230 STONTON, CA 95207 <br /> 6.Tranaporier t Cors3m y Nave U.S.EPA ID Hunter <br /> 7.7ransporier 2 Company Name U.S.EPA IU NunnW <br /> a,oasignatea Fairy Name arta liftAddrmYuma Yes, LLC U.S EPA 1O NumW <br /> E730 E. 13th Street <br /> Yuma, AZ 95365 <br /> FaciS 'S <br /> 9a. �.U.$.DtlT GsaerlAt xr{sn�ud�9 Proper St Name,Hazard Class,lO Nun bet, 117,Cants nets 11.Totaf 12.ilnft <br /> HM and Pacldnp Gawp(1 arty)) No. Type ouwbit MAV. <br /> 13.Waste Codes <br /> on RCRA hazardous waste, liquid {Soaps, 2 DF 00360 P 331 <br /> otissTrs), <br /> Z z <br /> LU <br /> 3. <br /> d, <br /> ta.Spoda1 Handpng I„sevd ana AWft%N Informabon 1. 110902{gat a t e Regulated Liquids 3 <br /> Y706-7c--3 <br /> 15 GENERAT0R'S10FFEROR'3 CERTIFICAWN: I hereby dedam that the contents till Lh s sonsrgWMI.are NSy arta aceurattrly descrlbed above by To propel shpping name.and are dassifed,packaged, <br /> rna&A and label9 Vaoarded,aM are in all respects in proper condition for transport&=ding 10eppkable irftma6orklamf nali)nal goverrrnenfal mgulationa.if eVort ahipn ent and I am the Printery <br /> Ex)uw,,I Certify tial ft cntuants.of;his ConsiCnmeM mnlorm to the berms of the AudW EPA A*vA4rgnenr of Coogan'. <br /> I oer*#W the Wasle rrinirr&�Wian Swerrmt identified in 40 Ci R 242.27(a)(€t 1 am a large quantity gerlemW)or 0)Sitz am a vW qux$ly generator)is he. <br /> Genr49e-&,S rM Nam behalf of LifiteMomh Pay Year� <br /> .MNEXU�W Shipments <br /> s 16 <br /> ❑IMP04 tG Us. ❑f xvart tram U.S. Poi of anM.At _.__.._.. <br /> 9 7—sporter (W exports*1►y)I £Yale leaving U.S.. <br /> oC 17.Tmnapx*Adv+andadgment of RocekX of WoniWs <br /> WTranspoRer 7 PrAHed7t Name s7:ao- NbrA Day Year <br /> K Isidro Martinez 107 109 10PA <br /> En Traworter 2 Pmltedtfyped Name 5 grahxa Month OW Year <br /> 18a.usawm Irdmtkyn Space ❑ Csrentity ❑Type ❑Rosldere ❑P10,1 R*,W- '^1 F[Al R(4 r,6W <br /> Mandest Roterwim Number, <br /> 18b.AKemats facility(or C*W ) U.S.EPA la Number <br /> J_ <br /> C] <br /> IQi Fao9ryls Phone: <br /> 18C. rlalura FW,*O <br /> AlWrOW Fr GenersWil fltDntt! Day Year <br /> UjF <br /> 47C <br /> N19.Faz Wash Report Mx4,;en*nt Method Codes(.e.,codes fpr huard s wase treatrnml,disposal,and rocyo rq sysEems) <br /> 0 1. 2. 3. 4, <br /> 20.Designated FWJ4 Owner or Operator:CertipceWn of fecelpt of hazardous materWs Covered by the mardest except as nded m I!em 1aa <br /> Prinledffypad Name Signature Month 03ay year <br /> YLt U, LAIUa -4 V�l Pap <br /> EPA Form 870N2(Rev.t -17)Previous editions are obsolete, DESI04AM FACILITY TO EPA's e-MANIFEST SYSTEM <br />