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Please print or type, Form Approved.OMS No.2050-0039 <br /> UNIFORM HAZARDWS 1.Genalata ID NUMW par I Of 3.Emw9ency Ftesponse Puma 4, <br /> WASTE MANIFEST UOU427616 1877577PFAS Im!"C1731"2uff4001 F L E <br /> 5.GewaWs Nam w4 Mailing Address Get*�s She AMW(if dftW Itm me"and <br /> Bath & Body Works 1510 Bath & Body Works#1510 <br /> 2094729339 4950 PACIFIC AVE, WEBERS OWN MALL/ SPACE 4950 PACIFIC AVE <br /> Generator's N*ft: STOMTON, CA 95207 STII � TON, CA 95W <br /> 6.Tranporter I Comp". Name U.S-.EPA 10 NLdnW <br /> StericVcle lipeciAlty Wjjjje 9 lutions Inc M&cM 116924 <br /> 7,Transpor*2 Company Nam US,EPA ID Number <br /> Worldwide..HCr,Qyjty Bystess ICBRM175422 <br /> 8,Designated FackyNxneand 9ftkWres&yUIla Yes, LLC US.EPA ID Nurnber <br /> 2730 E. 13th Street <br /> Yusa, AZ 85365 <br /> FadHty`sPhorwQPgr,4PAq-jA <br /> 9a. 9b,U.S.DOT Desail%an(ding Proper Shipping Name,Hazard Coos,10 Numix r, 10.Containers It,TOW 12,uwd 11 waste codes <br /> HM and P-k4Vr—p(K-y)) No, Type Quantify WUW' <br /> 4ion RCRA hazardous wastes liquid (Soaps, 1DF 00122 P 331 <br /> -otiotts), <br /> Z 2 <br /> W <br /> 4. <br /> %S; Fi;;k—V In and AddWW <br /> 1. 110902(Stat Regulated Liquids) <br /> 15, GENWTOWSWFEROKSCERTWICATM:Ihw9Dydec1xeVWthe cwWftof aro y ark acxwrs6ety above by tae pry shiRpis i rr&ne,and are packaged, <br /> marked andnd aam tires map"in prWoxWW for transportExpoder,I ce*#,aII <br /> I the mnj"of M mmignmam=*rm lo 9*temp ot the ads wd EPAA&Iow"ment of Consert <br /> I w*diat Me iwasts mwwrhaton statement identified in 40 CFR 262.27(a)#f I am a qe qw0y 9weratm)or(b)(01 am a smal van*generator)is true, <br /> Genwatoesf0r*Ws Pdrftdffyped Name n aR re -n,)beWf of Lisite Month fly Year <br /> 111 113 k919 <br /> 16,tntwnatiortal ShOwnIs mimportlous. P Export ftm 1). . Port of mtry1wit <br /> Lw_w*sign*xs(6expwbo*), Dry U.S.: <br /> fY 17,TrarWW AOwWedgmenl of Rooelpt of W" <br /> Trenspwter I Pf"edfTyped Name M0* Day YW <br /> 0 <br /> & Jared Marci e I 61is <br /> T- 2 ftftdnywd Nam ► C" year <br /> 18.Discrepom <br /> 18a,D&repancy hficabon Space El DTypa EIR.W. E1P&WRe*bw tJ Full R*Ojm <br /> k4arKast Reference Numbec. <br /> 18b.Alternate Fac&ly(or GwwdW) US,EPA ID Number <br /> Z' <br /> w F.Ws Pt.: <br /> C3W 18e,Signature ofN*nate Fad* rear <br /> (orGenei;53 Day Ye <br /> 19.Hazardous Waste Repot Managemert Me#wd Codes Ike,coda$or hazambus waste b wbwwt,dsposal,and mqcrong Systems) <br /> Uj 3, 4, <br /> 20.Designated Factdy or Operator Cer9kabon of moW of hazardous materials 22JLW by the manifiest acept as in tram 189 <br /> 1111n1,6Typed'11a"/) SWAKe morilDay Yew <br /> CAQl-M JAV 1)/IN4 I - i I'l <br /> EPA Form 8700-22(F*v.12-17) Previous edition are obsolete. Dt$041)FACILITY TO EPA's e-MANIFEST SYSTEM <br />