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Please print or type E R 1111 llllll 1-1.1 � IIII�I 1.Generator ID Number ""�� Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS ?aue of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000427614 L 1 (877) 577-2669 FLE 5.Generators Name and Mailing Address At t n;Jody Terrell Generator's Site Address(if different than mailing address) Bath & Body Works 65 Bath & Body Works#65 2099524396 2 Limited Parkway 5308 PACIFIC AVE Generators Phore. t 6.Transporter 1 Cmpany Name U.S EPA ID Number 7.Transporter 2 Company Name n c MdS0001 10924 U.S.EPA ID Number B.Designated FacilihyName and Site Address General Environmental Mgt, LLC U.S.EPA ID Number 11855 White Rock Road Rancho Cordova, CA 95742 Facility's Phone: 91635�.09$4'! CAD9@0@@4183 JHMand GOT Description iincluding Proper Shipping Name,Hazard Class,ID Number, king Group(if any!) 10.Containers 11,Tolal 12.UnitNo. Type Quantity Wt.Nol. 13.Waste Codes Of RCRA hazardous waste, solid (Soaps, 1 DF 00179 PQions), UJ _ ` Non RCRA hazardous waste, liquid (Soaps, 1 DF 00215 P 331 Lotions) , 3. i 4. 14.Special Handling Instructions and Additional Information Liquids) 1, 110903(State Regulated Solids) 2. 110902(State Regulated . 15. GENERATOWSiOFFEROR'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 laL'ed/placarded,and are in all respects in proper condition for transport according to applicable internationaland national governmental regulations.If export shipment and t am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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)lift am a small quantity generator)is true Generators(Offerors PrintedfFyped Name Signature SR L re Qin Month Da Year �vv>L41�--�,�_ o f L i m i t e y ri 16 international Shipments 1 0 20 ❑Import to U.S. ? Transporter signature for exports only): ❑Export from U.S. Port of entry/exit: W 17.Transporter Ackncviedgment of Receipt of Materials Date leaving U.S.: LU Transporter 1 Printed,` ed Name p Signature �_ c _ EL]NIonth ay Year 6- Kristo)3her AlmanZa ____'==:o-:--- Z Transporter 2 Printed;-yoed Name 0 Signature H a20 y Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Padiai Rejection ❑Full Rejection 18b.Alternate Facilihf r Generator) Ivtanifest Reference Number: d U.S.EPA ID Number U LL Facility's Phone: W 1K Signature of Alternate Facility(or Generator) Z Month Day Year w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,and recycling systerns) 0 1. 2. 3. 20.Designated Facility Juner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pnntedryped Name Signature Month Day Year EPA Form 8700-22(Rev. '2-17) Previous editions are obsolete. ! //�