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Please print or type.(Form designed for use on elite(12-pitch)typewriter,) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 1 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000427614 1 8775772669 010868399 F L E <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Bath & Body Works 65 Bath & Body Works#65 <br /> 2099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFIC AVE <br /> Generators Phone: STOCKTON. CA 95207 STOCKTON CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 ompay N � U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address 1st Cen ury EMN, U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone: 7755752760 NVD980895338 <br /> 9a_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Vol. 13.Waste Codes <br /> X 1UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 CF 00013 P 3311 D0@1 l U@02 <br /> Alcohol, Acetone), 3, PG II, ERG#128 <br /> I <br /> X 2UN1950, Waste Aerosols, [flammable, (each not 1 CF 00002 P 331 D001 <br /> exceeding 1 L capacity)] 2. 1, ERG#126 <br /> I <br /> 3. <br /> i <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1. 110905(Flammable Liquids) 2. 110904(Aerosols, Flammable) <br /> 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, <br /> marked and labeledlplacarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(i I am a small quantity generator)is true. <br /> GeneratorslOfFero s rinted(Typed Name Signature y <br /> S L rep beh if of Limite °nt a ear <br /> 74 J1 16.International Shipmen ❑ <br /> 04 @3 201 <br /> I-- Import to U.S. ❑Export from U.S. Po of entry/exit: _ _ <br /> Trans ortersignature for ex ortsonl : Date leaving U.S.: <br /> UJ <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter t Printed Typed Name ignature onthay Year <br /> a <br /> Johnn Harper 04� @3�2@1 <br /> w <br /> 11 <br /> Transporter 2Printed(ryp Na Signature Month Day Year <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> _J <br /> U.S.EPA ID Number ' <br /> V <br /> Q <br /> LL Facili 's Phone: <br /> W 18c.Signature of AHemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> W19.Hazardous Waste Report Management Method Codes(i.e.,co es for hazardous waste treatment,disposal,and recycling systems) <br /> UJ F20. <br /> —MI <br /> 3. <br /> 4. <br /> esignated Facility Owner or Operator:CeriifirZ�ation of receipt of hazardous aterials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature on y <br /> I- U)n0 V- <br /> / r <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. DES :NATED FACI TO D TINATION STATE(IF REQUIRED) <br /> 8700-22_12v3 C8293378 S41067816 041077444 M PD040318 9D040318 <br />