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Please print or e. Form designed for use on elite 12- itch typewriter.) I Form Approved.OMB No.2050-0039 P YP ( 9 ( 2-pitch) YP ) PP UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 1 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL0004276141 8775772669 010790369 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: RTnCKTON, CA 95207 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address 21st Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone: >_ ga 9b.U.S.DOT Descdplion(including Proper Shipping Name.Hazard Class,ID Number. 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nal. W X 1 UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 DM 00055 P 33 D0011 0002 Alcohol, Acetone), 3, PG II, ERG#128 w Z 2. i ! 0 IV i f 3. i f 1 4. I 14.Special Handling Instructions and Additional Information 1. 110905(Fla®enable Liquids) 15. GENERATOR'S/OFFEROR'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. Generators/Offerors Prinled/ryped Name ignature �imite Monthay Year �/ SR r an behalf o oV -e-�(,,"mac i C- E �s"� - J 16.Internacional Shipments i1- ❑Impart to U.S. ❑Export from U.S. Port of entry/exit. Transporter signature for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year >z , �i Transporter PInte ype ame Signature Month Day ear H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity EJ Type ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number: H 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q LL Facility's Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year Ll Z Z rn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment..disposal,and recycling systems) � 1. 4 2. 3. 4, 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed N e • � /'4� lure M�th (a Y r EPA 11orm 8-700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACiL TO TION TATE(IF RE'NIRED)