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Pleasa print or Form Approved.OMD No.2050-0039 <br /> -TPil 3.Emergncy Response Phoracking Number <br /> UNIFORM HAZARDOUS <br /> IG—Mb 27614 8775772669WASTE MANIFEST C <br /> L E <br /> s.Genera ors t oma and Mooing Addresgat h & Body W D r k 5 65 Generates Site Address nt different than mailing address) <br /> Bath & Body Works#65 <br /> 2099524396 5308 PACIFIC AVE. SHERWOOD MALL/ SPACE 6 5308 PACIFIC AVE <br /> Generator's Phone: <br /> 8.Transporter 1 Company Narr* U.S. PAID r <br /> 7 Transporter 2 Company Name U.S. A <br /> ID <br /> Worldwide Recovery Systems <br /> 8.Designated Facility Nabs and Site Address Y U■a Yes. LLC U S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facility's Ptxe: 92$6428938 AZR000515924 <br /> ga 9b.U.S.DOT Descdptlon(Including Proper Shipping Nacre,Hazard Class,10 Number, 10.Contaners it.Total 1 12,Unit 13.Waste Codes <br /> HIM and Padvrg Group(if any)) Na. Type Quantity W.Not.. <br /> Non RCRA hazardous waste, liquid (Soaps. i DF 0016 P .31 <br /> 1 <br /> Lotions). r <br /> 2. Non RCRA hazardous waste. solid (Soaps. 1 DF 0011 P 3 1 <br /> Lotions). <br /> 3 <br /> f <br /> i <br /> 4. <br /> j <br /> 14.Special tiandrngInstructions andAdetona)Information 1. 110902(State Reoulated Liouids) 2. 110903(State Reoulated <br /> Solids) <br /> 15. GENERATOWSM"EROR'S CERTIFICATION:I hereby declare that the contents of this consignment are tufty and accurately ecWIW above by the proper shlpphrg name,and are dessified,packaged, <br /> marked and tabek d oacarded.and are in all respects in proper condition for transport a=dmg to applicable iniemationaland national govammaniel regulations.d export shipment and I am the Primary <br /> Exporter..I certify that the contents of ecus=mi9rxnent conform to the terms of the w3achod EPAAdmawdadgmant of Consent. <br /> I certify that the waste mmnnzation statement identified In 40 CFR 28227(9)(iftarn a large quantity generator)w(b)(il m a smalt guar"y ratrej s true. <br /> Generate s Pr ntarNyped Signature L r e p e h a l f o f L i mite Month Day Year <br /> rr 0 1 20'0 <br /> J 7f3.1nlernaponel Sh pm�n Im to U.S U Export hon U.S. Part entyrexic <br /> Transporter agnahce(for exports only): Dale lean ng U.S.: <br /> oc 17.Transporter Acknowledgment of Rewe of Materials <br /> Transporter 1 PunteNamyTyped NaS gnatuva Month Day Year <br /> PL Johnny Harper 0 1 22f' 0 <br /> Z f ansportar Z PnMed/Typed Name Sig lure Marrtl Day Year <br /> Y��,� � ( _t lit�1 . �.�►' ..�., l7 <br /> 4 <br /> 18.Discrepancy <br /> I 8a.Discra�bancy Indication Spare E]Quantity Type EIResidue ❑Partial Rejection ❑Full Rejedian <br /> Manifest Reference Number. <br /> S8b.Ademate Facility(or Generator) U.S.EPA ID Numher <br /> V <br /> FaalitysPhore With Da Year <br /> W 1Ito.5ignature of Altemale Faafity(or Generator) y <br /> z <br /> S2 19.Haze dors Waste Report Management Meta Codes(i a.,codas for hazardous waste treatm 1,disposal,am recyclIN systems) <br /> c 1 NIAIA Z <br /> 20.Desigrrdtea Facility Owner or Operator;Certification of receipt of hazardous matgnals covered by the manifest except as ncted in Item lea <br /> PrintedlT Name Signature h"M Da' Year <br /> EPA Form 8700-22(Rev 2.17) devious editions are obsolete. j3 GNATE A ILITY TO EPA's e-MANIF EST SYSTEM, <br />