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Please print or type. [. <br /> i.Generator 10 Number Fpr r ApprOYed.0.78 No.205i1�033 <br /> UNIFORM HAZARDOUS 2.Page t of 3.Emerges y 3espanse Phpn? 4.Mw.nMennst7racktngteumber �j <br /> WASTE MANIFEST CAL000427614 i 8775772669 U 3© 7 F�. <br /> 5.Ge rerators Name and Haling Address GeneraWfs Silo Address(if different than Fsalting address) <br /> Bath & Body Works 65 Bath & Body Works#65 <br /> 0995224396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFIC AVE <br /> GeneratprsPtx., STOCKTON CA 95207 STOCKTON CA 95207 <br /> B.F anspoder 1 Company Name <br /> U.S.EPA 10 NurM�et <br /> Steric ole Specialty Waste Solutions Inc hfNSe@01Vef <br /> 7.Trarrspoder 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Designated FadktyName and Sitio Aft, C6 _ 0,0 i .- <br /> Yuma Yes, LLC U.S,EPA.ID Nurri r <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facif:,{s Ftrone <br /> 9a. 9b.U.S.DOT Description tmckxling Proper Shipping Name,Hazard Class,10 Numbor, 10.Contaice� c. <br /> H t and Pac ng Group(if any)) 11.Tota) 12,Un t <br /> 1 No. Type Quantity MJV01. Q.Waste Codes <br /> 0 on RCRA hazardous waste, liquid (Soaps, 1 DF 00073 P 331 <br /> otions), <br /> w <br /> z z. <br /> W <br /> c� <br /> 3. <br /> 4. <br /> f4.Special Handling Instructions and Additrcnal intentnat on <br /> 1. 110902(State Regulated Liquids) <br /> In al rasp"in proper a aW-S c t <br /> marked and lsbelef <br /> 15. G1 NERATDR'&QFFEROR'8 CERTiFlCAtit?M:I hereby declare!hat the conknts of"S w"rxnent are My and accurafery descriged above by}�properstdpp rg came,ant are lass fled,packaged, <br /> and rdttiarr(or rpt g to 8lspfiCahla IMEtt12t16tia12(d national <br /> MA <br /> Exporter,l comfy drat the contents of tt'as consignment conform to dio lenm of Iha arched k Miled7ra t of Consent. � 'll export shipment and l am the Primary <br /> I certify that the waste minimization slatemem Identified in 40 CFR 262.27{a)t91 am a large quenbty getwolor)or(b)(di am a smej uan6 <br /> Ganeraia'slpf(erots PrintarflTypesJ NarareP Ona l f (Til" L i a i t e M«,d Oar Year <br /> 019 <br /> 1&.tn6erna6otraf Shlpmartts �� <br /> -F— El Import to U.& Ell:-)poi I from U.S, Port of entrylexit: <br /> Z Transporter signatlrre(fa exports only): <br /> Date leaving U.S.: <br /> W 17 TrarxporterRdmordedgment of Raceot of Materials <br /> Transporter i Pnatypaif Name <br /> ir <br /> Sigrahrre Month flay Year <br /> N ared Marciel <br /> z r raasporter 2 PnntedlTypad N S. f 1 19 019 <br /> 1 Month Day Year <br /> ~ "i f < r•^ <br /> Is Disrxepancy ZJ / <br /> t8a. <br /> Di'saepantyIndication Space <br /> ❑Chsnlity ❑T"pe ❑Residue 0 Partlat Rejection D Full Rejectian <br /> 186.Aliernale Fac lily(Or Generator) Manirest Reference Number, <br /> U.S.EPN)D Number <br /> U <br /> L'2: Facility's Phone; <br /> W 180-Sig na!ure of Altamale Facility(or Generator) <br /> z tiro Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i,e.,codes for hazardous waste i eatnent q s <br /> w Pte.end eq ding systems; <br /> o t 2. <br /> L <br /> 20.Designated FadUty r r or Operator.Cer�aWn of receipt of hazardous materials covered by the manliest except as noted in Item Ilia <br /> Frintadrryped Name <br /> Signature _ Nonth Day Year <br /> EPA Ferro 7) Previous editions are obsolete !i -S FAClLITY TO EpA's a MANMEST SYSTEM <br /> i7SiG, <br />