Laserfiche WebLink
111111111111111 <br /> Please print or type. Form Approved OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11,C.-ne'atorIONumber 2.Page f of 3.EmergencyResponsePtwne 4.lAamilest Traking Numbr <br /> WASTE MANIFEST CAI 00042761 , 1 8775772669013658918 FLE <br /> 5.Cieneratoft(same and gaiting Address Goneraior s Site Address(if different than matting address) <br /> Batty & Body Works 1510 $at'­ & Body Works#1510 <br /> _2094729339 X4950 PACIFIC AVE, BERST WN'' MALL/ SPACE 4950 PnCIFIC AVE <br /> fiac'fle€a,o(sPhdrae PTCI t naCV' ',. <br /> fi Transporter 1 Company Nam U.S EPA iD Number <br /> r - - <br /> m <br /> r� ,_ -R-. w U. A <br /> 7 Transporter 2 ot5lpany <br /> 8,t}BstrJr 33ted F Name a (855 <br /> U-1, <br /> Y€ase Yes, LLL. <br /> P7`0 7` E. 13th Street <br /> YuKa, AZ 6536'5' <br /> Facaityr`s Pune=- - r -� <br /> gat 9b.U.S.I?1ST t Co o tet.ng Proper Shiypng Name,Hazard Gass,ID Nm taer, 10.Containers 11;TOW 12.Unit 13.Waste Codes <br /> HM and Padertg Grow(d any)) No. Type Maty, wtjvd. <br /> t <br /> +� ar f1 r id azav>d tus waste, liquid (Soaps, DF 0136 R 331 <br /> 0 <br /> t_Dtzons)g <br /> w <br /> a; <br /> a. <br /> I <br /> 14,Soria(Hwdhnp ktstruciiruts ars!Additiaa'at Information <br /> 1. 110902(State Regulated Liquids) <br /> 15, GENERAXOMSIt}MROR S CERTIFICATM?M;I hareb'y dedare 0A the is of the mrls raven are fully and amour*descnberl above by the prvpar shipls v Mw,aW sre dass{Ied,packaged, <br /> marked and ,and are in all respects in pmW for bwswd aomnling to spplicabfe Innen Wnala d natKlnal gowttmental regulations.Heatpirzt shipintint and 1 am tt*RWWY <br /> ExpoM�I owtity W ft contents of this c onsif)W £cmfwm tollte ISM Of the attest EPA AiOmwlecigment of C.omnL <br /> I W*that ire waste mirjistatement` in 40 CFR 262-27(a)(if I ant a large quantity generator)or(b)(d I ant a small€Iuar dy generator)is - <br /> __ } <br /> Generator's,+t>iku'o(s PrintadtPyperf Mw6 flay Year <br /> S"ture <br /> 4 <br /> SWIL ` � "L <br /> w <br /> beih <br /> 16.In nal Staliments Q h"Pon to U.S. Prat of eatry;ea- <br /> Transporter signatt a(for exports ora}). (lata WVN U.S.: <br /> a: ,7.TransparterAok of Recet>t of , <br /> Tr,.W" Signature taondr day Year <br /> AMAPA <br /> Z �e <br /> � I <br /> 3 e��' - �„� lit �`d,..��*F ,•" .d� �' '�°; `�.�,fr- �' °�1�i a�.�'t <br /> 18,Discrepancy ( � <br /> 188,Discrepancy Irxt cstfuxxt Space ®ouahmy Q T}pe Res rkae L 7 Partial Rejection IJ FWt Re ect rx <br /> Manifest Reference Number: <br /> 18b,A#temate Facility(or ) U.S.EPA D Nrat ber <br /> Facility's Phone: MDrAh Day Year <br /> 18c.Signature of Alurate FacBity(w Genera} <br /> 0 18,Hazardtut Waw Report Management Method (i.e.,codes for haxwdm waste treatment. ,and recycling systems) <br /> U1" t , 2. - 4. <br /> LA <br /> 20:Designated Facility Ou r or Ope€ator;CWation of receipt of hazardou9 materials amrad by Ste manifest excePt as"ed in(tart 18a <br /> Prii to i€T signe rO Mcntts ay Year <br /> - r5 <br /> WA G L <br /> EPA form 87W22(Rev.12-17) Previous editions are cbsciloW DEqIGNATED/AMUTY TO ERA'S 0-MANIFEST SYSTEM <br />