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111111111111111 -, <br /> Please print or type. Form App roved.OMS No.2€}1U£[)39 <br /> UNIFD}2I41 HA7hRDDlJS 1.Cw era rx ID mhes2.Pa3 1 of 3 Ewesge uy Response Phone 4. ifesl Tracking urnt�r <br /> WASTE MANIFEST CAL000427616 1 8775772669 p� 3���3�4 F L E <br /> 5 Ga .ratar's Name aM Mailing Address Generabrs 5st8 Address(if dMerent Shen rlai'usg addvss) <br /> Bath X Body Works 1510 Hath & Body Warks#1510 <br /> 2094729339 4950 PACIFIC AVE, WE$ERSTOWN MALL/ SPACE 4950 PACIFIC AVE <br /> GeneraWi',Phone: STOCKTON CA 952207 STCICKTm CA 95207 <br /> G TFang*Q%r t Company Nano U.S.EPA ID Number <br /> Steric cle Specialty Waste Solutions Inc IMNS000110924 <br /> 7 Tr,~thr 2 Company Name U.5.EPA ID Number <br /> p - <br /> 8.Cesgoted Fadlity Name and site Adam( Y U V a Ye 5, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, A2 65365 <br /> Faali: s Plspne:928642B938 IPZR000515924 <br /> ga. 9b.U.S.DOT Desuip"(kWirrg proper Shipparlg Na".hazard Class.ID Number. 10.cmla;re 5 11 Total 12.Usti! <br /> 13 V'I'Ve'cde5 <br /> HM anld Packing Gaup(K My)) Ne. Ty, <br /> Qu n!srr JJ.Na. <br /> 'Non RCRA hazardous waste, liquid (Soaps, 1 DF 00105 P 331 <br /> a Lotions), <br /> a <br /> ua <br /> ua <br /> C) <br /> 3. <br /> 0.. <br /> 1$.spews Himwv Irarucbms and Additional Information I,110902(St at e R e g u I at ed L i q u i d s) <br /> 15 GENERATOR'S'OFFEROR'S CERTiFrCATEDN:t ful.y and accurately devhbedl abm ty rhe proper shipping name.and are da`'sffed,packaged, <br /> marked and iabeie Vacarded,aW are m all mspecrm h1 proal cmdftsar,for traMPW ao2of0 m g to apphcaote ir-,Eemlatiralaf and nobonal goverrrnen al regdahorls-I export M pmew and I am rhe Primary <br /> Exporter,1 cer*tial fie conte&a!this cxegnmerri=Yorm to IN tsvm8 of rhe attaOW EPA At*roxecigm ril of Consent <br /> 1 Certify 11W"vraa!e rake 1wic n statem m MmbW in 40 CFR 262.271a]fn I am a Wr quantity geriermor}or t'b)(dr am a arn43s quanMy generator)m true. <br /> GenetWONO%rors PrnWT "arae U,,' j` Signa ore behalf of L it m i t e l"•th Day Year <br /> [��( �''+�� 09 19 015 <br /> 16 lnlernabonal.Srrpm m <br /> F ❑Impm to U.S. ❑Exw warn U.S. Port o'eavyrea <br /> x T rarsWerrnanxe(for ex — __.......— <br /> 519 P�anEylt Dace leaa�U.S.: -- <br /> rni 17.TraporterAftowledgrnerd of Real of hlareriais <br /> 7ransp lu 1 PrdrN Typed Name Sicnature <br /> S*m h Day Year <br /> a Isidro Martinez % 0909 19 hoig <br /> � Tr a !edTyped N me �r a gnaturp} LI [ bay <br /> Ye <br /> as <br /> tl�C l�i1 <br /> 18.Discrepancy <br /> :5a.DisorepanCy Irw'iCatlOn Space ' ' <br /> Oua a;ly ❑Typr L Re>lua ❑Paitiel Rein 0 Fu'I Rele t w- <br /> Manless ReSerence Number. <br /> F SEh.Allema a Far7ity fa Generator) U.S.EPA ID Number <br /> a <br /> 0 <br /> �E varoi!y's Phone: <br /> u�.r tncc.Signature of Alternate Fa"(or Gemralor) Month Day Year <br /> 4 <br /> z <br /> cn 19.Ra7arddus Waste Report MWnagament Method Codes(Le.,oodus for hazardous waste 7ealrnent,dime al.And recydirg sysWns) <br /> UJS 2. 3. e <br /> a <br /> 20.Desynated Fad6lt owner or Operator Cerbkalacn W rept of hanrdms matanals covered by ane m&rg1W except as rated m rem 18a <br /> Pnnted'TyW Namo (g al re M04, oay YEar <br /> ��(W 110101 ICT <br /> EPA Form 8700.22(Rev.12-171 Previous editions are absofele. ❑I S1 C]FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 8700-22 12v3 CAPS i37A qAi Aa7Acm nz�i S-2anc-2 M <br />