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1 �Gi,'ppJ, a <br /> P case print or type.(Fo.!des fined for use or elate(12 pitch]hfpr wri?er.) �! �` � �I':�" .X <br /> FCrrt App.c.ed.0"'B No.2050.100;39 <br /> UNIFORM HA7ARDOUS I I Dere;wv ID Number ?aye f a' 3.Emergency gest ars:,Phone 4.61anitest 7racKrng Number <br /> WASTE MANIFEST l r = 1 C 012121191 F L E <br /> b Crttrato.;Ner^e -c.t;:mrr.:.=,.;n-;� a:ns�zEr,-r's S�e�Jilress ri Giderfnt lila^n=,-�=i^�adCres;� <br /> Hath & Body (;larks 65 Path & Body Worl(shG5 <br /> 2099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE E 5308 PACIFIC AVE <br /> C:re:.utY,Prlne: STOCKTOtV CA 95207 STOCKTON 952@7 <br /> C.TfarSporw I Gof';P3.y tare <br /> US EPA 1D Num_a• <br /> Steric cle Specialty Waste Solutions Inc NS000110924 <br /> ?Trar:curter Z C.�tpany F.'ama U.5_E?A ID%rr64s . <br /> Worldwide Recovery Systems CAR00017542)2 <br /> 8 liesignateeFac,<:h,+NaT a*c SateAMriessYURIa Yes, LLC v.s.€EAtt}rdn:acr <br /> 27300 G. 13th Street <br /> f� <br /> Yuma, AZ 853G5 <br /> r= <br /> U.S.DOT C•esc pL";n+i:r�,;d:-a P+a er St•i:;raty fvarre,Harr:Cass,Dr��mbz•, 1t;.Ca•rla::ea <br /> Flrt artPa..cngi2-c,:F,ila:ey; tt.�aial 12.Llml _ <br /> ho Type Oran!€! yVt.,•'tc�t� <br /> 13 <br /> ac Ikon RCRA hazardous waste, solid (Soaps, 1 DF 01b,108 P 331 l <br /> I- Lotions), <br /> w Asan RCRA hazar-dDUs waste, liquid (Soaps, 1 DF 10155 P 331 . <br /> z <br /> w— i ----- <br /> I r <br /> y4 533 r Fu <br /> id110903(State Regulated Solids) 2. 110902(State Regul7edgUl.d5) <br /> 15 GENERATOR'S+OFFEROR'S CERTIFICATION:I hereby dedare!hat the('mew of this con4nment are filly and a^cvsate!y dewribed above by Iha <br /> aropershr n,rare.alxtarec . <br /> sari 2d and bee d'placarded,and are m a'I respects n proper Con t1itn fa!ransta+t act:crdng to appiicab a imernatic9A and ra!irr+taf go ernrcenta;r ulaf�rs espart shtpsxe^s and I o h In p.nary <br /> E€porter.I sefki ttal the contents at th s tarts 3n ment ra^farm to the terms of a:e anached EPAAckwivledgment of Co meal <br /> I ce4h'(nal the waste mfnimizatier:sta'ernerl adeo5fied in NO CFR 26227(a)(i'I am a large qu3ntiIy gerwrator)or b)(if I am a small qua^€t/ge,•!erator)is trie. <br /> Gerxrata'SfOHeror's .r:eed yped NamebigmaireJ <br /> W ��r 1--'k7 �Z b alf of Lieite 'a <br /> L0 018 <br /> rc U St C ar .S raK en.r r- <br /> iratu^,rte"si•-•attre rs e...;;o sDare ,iv nU.S.. <br /> LU <br /> 17.T-'ar;porter AcK w�wWdgntert td 4e,:',t e'htive-As <br /> O ;tar.-spotter t Prtuei7yGed Name ignMwe axL: y rear <br /> co Mar- i e I <br /> Trac ter 2 Priv edrTyped dame <br /> r�rla';;re - - _ il Day f � 3'ar1' l Fea. <br /> �G<4tvct - -C. <br /> t8 Ds�rep-r�y <br /> Pan <br /> 181Va=fes'Pcfe!en.e Numbpr. <br /> US EPA ID Num(-- <br /> J <br /> U <br /> Q <br /> LL Facry's PherNi: - <br /> w -I6c.S:gnalore ct At!wnate FacilcK(c.Geneimzor <br /> z <br /> h'.srx.r-r:ent Art:tr:;t Cwes t+e.codes far hazardrus rl>:=.!-almant.j-5.s&i.wd r�yciatq s--:;...r.: <br /> Q Uj3 <br /> R r+ cr;cri C r i ':anotre a:p alrazaecc_5ca,ern:9 :e:>d hen r;( s <br /> Y by a estexcept <br /> s ` in;e... <br /> Sgiaturu <br /> t <br /> F„•m R-9r;22;Re:3-+75 PlieVOLIS ed+'ior•. re Ch. eta. ttt �4 <br /> t) -•.itr`!`?lEl;('A..i6Cl�t"(3llt'-Slli?A.)I)i Siiic(If I"(i'_GTUItiL(]) <br />