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1g,� I1l1111l11111 <br /> �•,�i;�se 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 t of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CALOOLA427614 i 87 75 7 7 22 669 010788846 F L E <br /> S.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> MBath & Body Works 65 Bath & Bodv Works#55 <br /> 209952-4396 5308 PACIFIC AVE, SHERWOOD MALL; SPACE 6 5-33108 PACIFIC AV <br /> Generator's Phone: STOCKTOIN, CA 95037 STOC TON, CA 9 J <br /> 6.Transporter 1 Company ame J.S.EPA ID Number <br /> Ster,icycle Specialty Waste Solutions Inc. [=E!`d90001109'24 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address uenerai Environmental , LLU U.S.EPA ID Number <br /> 11855 White Rock Road <br /> Rancho Cordova, CA 95742 <br /> ftFadfitysPhone: `3163510980 CAD980884183 <br /> b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit13.Waste Codes <br /> nd Packing Group(it any)) No Type Quantity WtNol. <br /> Non ERA hazardous waste, liquid (Soaps, I DF 0009533 <br /> t <br /> oLotions), — --- <br /> � ~ 1 t <br /> w2. on azar pus waste, soi oaps, DF �0090 33 <br /> Lotions), <br /> _...f I <br /> f <br /> 3. <br /> 4. <br /> S <br /> t f!E <br /> 14.Special Handling Instructions and Additional Information 1. 110900(State R e Ia_u 1 at ed Liquids) 2. 1 10903(St'At 8 Regulated <br /> Solids) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shlpptrtg rod .godare 7a§"sifted,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If ezp6i£5(xpm8yii and t am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)if I ama small quantity generator)is true. <br /> Generato sl fferor•s Print ped ame i gna ure L r e o n b e h a r 0 _Wm t May ear <br /> moi►- I' 0 201 <br /> 16.Internafional S pments <br /> ZLlImportto U.S. ❑Export from U.S. ort of entry/exit _ --- <br /> Tran iter si nature for ex its onl Date it eing U.S.: <br /> It 17.TmnsporterAcknowledgment of Receipt of Materials <br /> Transporter 1 Printedfiyped Name Signature ay ear <br /> CJohnny Harper I I 00 7 <br /> ZTransporter 2 PrintedlTyped Name ignatu Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space U <br /> ❑ Quantity 11 Type ❑Residue Paul Rejection 0 Full Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number <br /> J <br /> LLv <br /> a <br /> Facili 's Phone: <br /> FW- 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> U) <br /> LLJ <br /> In 1' 2. 3 4 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> tedfTyped Name-1 S1 Month Day Year <br /> gna ure <br /> EPA Form 87 -22 ev.3-05) Previous editions are obsolete. SIGNATELI FACILITY TO DESTINATION STATE(IF J <br /> REr.)UIREI]) <br /> A71?i1-,1 '> t==..f �A-�+=�7A 1.1>�t .?A1s. t1Lfi, , 7 iM YrD1 =ki317 SD1'0R17 <br />