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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> IMMUNE,! <br /> Form Approved.OMB No�IFLE 2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CA 000427614 3 <br /> 5.Generator's Name and Mailing Address 1 8775772669 <br /> Generator's Site Address if different than mailing address) <br /> Bath & Body <br /> 2099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFICWAVEs65 <br /> Generator's Phone: STOCKTDN CA 95207 1STOCKTON CA 95207 <br /> 6.Transporter 1 Company Name <br /> N <br /> Steric !le Specialty Waste Solutions Inc U.S.EPAID umber <br /> vIransporter2 Company Name ^ MNS000 1 1 0924 <br /> / U.S.EPA ID Number <br /> S.Designated Facility Name and Site Address General EnVlronmenta1 Mgt, LLC, A�-T U.S.P I�ber <br /> 11855 White Rock Road A <br /> Rancho Cordova, CA 95742 FALL;V <br /> Facility's Phone: 9163510980 <br /> 9a. <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, CAD981OM4183 <br /> HM and Packing Group(if any)) 10.Containers 11.Total 12.Unit <br /> No. Type Quantity Wt./vol. 13.Waste Codes <br /> X 'UN1993, Waste Flammable liquids, n.o. s. (Ethyl 1 CF 00016 P <br /> Alcohol, Acetone), 3, PG II, ERG#128 331 D001 0002 <br /> W <br /> j <br /> 2Ili Non RCRA hazardous waste, liquid (Soaps, 1 DF 00109 P <br /> IU <br /> Lotions), 3311 <br /> 3. <br /> 3! <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1. 110905(Flammable Liquids) 2. 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 Pr maty <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgm of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantitygenerato ( (if I am a small quantity generator)is true. <br /> Generator�lQffer is rintedrryped Name <br /> (,, �0 r 1 k ignatur <br /> vl ✓ T'� ( O f/!�it'� on ay ear <br /> i 16.International Shipments 61 <br /> li ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature for ex ort-11 onl111 <br /> W 17.TransporterAcknowledgment of Receipt of Matedals Date leavinq U.S.: <br /> ce 7ransporter 1 Printedrfyped Name <br /> 0 ignature <br /> a I ont ay ear <br /> yI I I <br /> Z o Pi me , <br /> r gnature Mo <br /> 18.Discrepancy A 7 <br /> 18a.Discrepancy Indication Space ' <br /> ❑ Quantity ❑Type ❑Residue <br /> ❑Partial Rejection Elul Rejection ' <br /> 18b.Alternate Facility(or Generator) 2`S Manifest Reference Number: <br /> Y�{VYy <br /> v o� c,� �� .S.EPA ID Number <br /> Q 0775 SSS- 7bo '1�evr lanJJt Df`. �- J <br /> LL Facilil's Phone: ^e r <br /> 0 18c.Signature of Alternate Facility(or Gener ,f q (� 3 S� <br /> Q O <br /> Z Month Da Y <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 / I 2. t <br /> +-1 � 3. 4 <br /> 20.Designated Facility Owner or Operator:Ce t fication of <br /> Printed/Typed Name receip of hazar� dous materials covered by the manifest except as noted in Item 18a <br /> Signature <br /> Month Day Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />