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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) I Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000427614 8775772 6 9 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Bath & Body Works 65 Bath & Body Works#65 2099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFIC AVE Generators Phone: STOCK ON, CA 95207 STOCKTON 6.Transporter 1 Company Name U.S. PAID Number Steric cle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name nn U.S.EPA ID Number �S8 8.Designated Facility Name and Site Address 21st Century EMN, LLC U.S.EPA ID Number 22095 Newlands Dr. East Fernley, NV 89408 Facilitys Phone: 7755752760 NVD980895338 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 'UN1950, Waste Aerosols, [flammable, (each not 1 CF 00004 P 331 D001 o exceeding 1 L capacity)] 2. 1. ERG#126 W 2 , Waste Flammable liquids, n.o. s. (Ethyl -BMF 00318 P 331 D001 U002 Alcohol, Acetone), 3, PG II, ERG#128 �F 3. 4. 14.Special Handling Instructions and Additional Information 1. 110904(A e r o s o 1 s, F 1 an s a b 1 e) 2. 110905(F 1 a m M a b 1 e Liquids) 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generatoes/Offeroes Printed/Typed Name Signature 5KUL rep on behalf of Limite Month Day Year � vt!/ 4sea zsm08 09 201 16.International S merits Import to U.S. 0 Export from U.S. Port of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: rY 17.Transporter Acknowledgment of Receipt of Materials UJI� Transporter 1 Printed/Typed Name Signature Monthay Year a Miguel Ayala 1 08 091201 coTransporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q Facility's Phone: OL 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z Cn 19.Hazardous Waste Report Management Method Codes `(ii..e.,Icodes for hazardous waste treatment,disposal,and recycling systems) LLJC3 1 411 2 l I 3. 4. 20.Design Owner or 0 ra r:Certification of receipt of hazardous materials covered by the manifest ex t as noted in Ilk 18a Printed/Typed Name Signature M n Da ear A I'll L-I?jn 1110.21 d EPA Form 8700-22(Rev.3-05) Pr vious 61ions are obsolete. DESIG ED FACILITY TO DESTINATION STATE(IF REQUIRED) 8700-2212v3 C8293378 S41067816 041174734 M PD080918 SD080918