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t. � INIIINII1�1�81�IINIIIIIII�fIIIIIIIIIIINIlII� Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 1 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 4 I 8 7 57,"17 2 1,69 009156172 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Bath ?: ±f Cr !'d orksf?E'. 20995Er4&36 5.08 !='AC I F T C AVE, S tE RWOt7Lr MALL:' SPACE 5 5308 PACIFIC AV E s_ Generator's Phone STOCKTON, CA 95.207 S T 0CY'T0N :A 9 5J_20 7 6.Transporter 1 Company Name U.S.EPA ID Number 'aic Pr•i.c;�c1r Specia 1t.' Wa�te So i�_ltion= nc ftlNSit,Q!0110`924, 7.Transporter 2 Company Name U.S.EPA 10 N . �4n -.. j. 8.Designated Facility Name and Site Address General Environmentall I p t, =C U.S.EPA 10 Number 11855 White Rock Roard? Rancho Cordova ICA `57 , Facility's Phone: y 16r 1038!✓ I t tD9$'J$$ 1 E�: 9a 9b.U.S.DOT Description(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity W1.Nol. I. UN = , Waste Aerosols. C1lammahle, (each not 1 CF 1r3 1.00 $ 1° 33 t10@ OF a}:Cee 3iru 1 L capacity)1 2. 1, ERG#126 - -- c i I UJ i( 2. UN1993, Waste Flammable 1 iquids, n. o. s, (Ethy 1 DMI 00097 P 33 DOO U;dk Alcohol, Acetone), AG 11, ERG#12$ -- -- �--- f r 3• Non RCRA nazardous waste. liquid (Soaps. 2 DF 002-82, F' 33_.k1 Lotions). __T 4. Non RCRA hazardous waste, solid (Soaps, DF -10075 P 3.:, Lotions). I 14.Special Handling Instructions and Additional Information 1. 1114 9l y.( e r o s o l s. Flammable) E, 110905(Flammable L_i 0 u 1 d s) 3 lieat. tc:tP. 1�eQl:lateL i_:couids1 L} i1Y'7ri3(L?at e ek 1a f , p_t et S-.11ds 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, 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 1 am the Primary Exporter,l 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 m a small quantity generator)is true. Ms/otf er's PrintedlTyped Namef gn Monthay Year U�/ 1 . mations Shipments %,_.,� '�V�/ I 0q Z ❑Import to U.S. ❑Export from U.S. Port of entrylexit: 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 aJohnny Harper I I tit o `01 QTransporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy indication Space ❑ QuantityType❑ YP ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U 4 LL Facili s Phone: W 18c.Signature of Alternate Facility for Generator) Month Day Year 4 Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1 2. 3. 7-t M rator.Certification of receipt of hazar ous materials covered by the manifest except as ted in Ito, Month a Ye �l" . EPA Form 8700-22(R v.AV Previous editions are obsolete. DESIGNATED FACILITY T TINATION ST E(IF REQUIRED)