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_ <br /> yr <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) ��a F irrrm Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Traki V V er 5 3 5 <br /> WASTE MANIFEST CAL000427614 1 18775772669 1 FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Bath & Body Warks#65 <br /> 2099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFIC AVE <br /> Generator's Phone: STOCKTON CA 95207 STOCKTON CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Steric cle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> , , k .- a �?2133 <br /> 8.Designated Faality Name and Site Addres .A /jam_) ^j�}� U.S.EPA 10 Number ?f <br /> 75-S�s'276d Tom"/ Irvv U.S. <br /> Facility's Phon . <br /> ga 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)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol, <br /> I= X bN1950, Waste Aerosols, [flammable, (each not 1 CF 00004 P 331 DO01 ( <br /> exceeding 1 L capacity)] 2. 1, ERG#126 <br /> X 2UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 DM 00060 P 331 D10101U002 <br /> Alcohol, Acetone), 3, PG II, ERG#128 <br /> Edon RCRA hazardous waste, solid (Soaps, 1 CF 00033 P 331 I <br /> Lotions), --i- -- <br /> Von RCRA hazardous waste, liquid (Soaps, 1 DF 00197 P 331 <br /> Lotions), <br /> 14.Special Handling Instructions and Additional Information 1. 110904(Aerosols, Flammable) 2. 110905(Flammable Liquids) 3. <br /> 11 3.45tat:e .Ragulated.Solids) 4. 110902(State Regulated Liquids) <br /> 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, <br /> 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 <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 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generofs Printed/Typed Name a u on ay ear <br /> N/Offr <br /> rirt. til i ra.mml <br /> J 16.International Shipments <br /> F ❑Import to U.& ❑Export from U.S. Port try/exit: <br /> Transporter signature for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> � <br /> Transporter 1 Printed/Typed Name Signature Monthay Year <br /> O <br /> o. <br /> xTranspo r 2 Print /Typed Names / ignatur on Day <br /> VL-11 1 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type ❑Residue ❑Partial Rejection Dull Rejection <br /> Manifest Reference Number: <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Q <br /> LL Facilit s Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. l ` 2. 1 3. 4. 4 (4 ( <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except ah noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> TL 911 I� <br /> EPA Form 8700-22(Rev.3-05) revious editions are obsolete. i?ESI ED F.4f'I1 TY TO DESTINATION STATE(IF REQWRED) <br /> 8700-22_12v3 C8293378 S41067816 040915610 M PDO82617 SDO82617 <br />