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Please pn*nt or <br /> UNIFORM1.Genea;or D <br /> HAZARDOUS I kvrr,bel _� _. <br /> WASTE MANIFEST � - t/�V31o1`}/�/j1 11 7.Papa 1 of a.EmerSercy Response Prong a.MaNtest Trecklrg Forku�Pmved.OM8 No.2050-0039 <br /> 5.Genera q s Marne are Ma u Address 1 8775772669 FL E <br /> Bath & Body Works 65 Gene2rots s e Add ass(t d!ere N than maing addross) <br /> 099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFICWAVEs#65 <br /> Generator's Pivne; STOCKTON, CA 95207 <br /> sPotter ICorr panyNa� STOCKTON, CA 95207 <br /> Po r2 <br /> Ste is N e S eci it W st Solutions nc U.S.EPA ID Number <br /> M 1 9 <br /> a 'te Yuma Ye , <br /> LL Nu <br /> 2730 E. 13th Street s.EP N er <br /> Faat,t AM Yuma, AZ 85365 <br /> 9a. 9b.US.DOT Gesarp on Qndud:ng Proper ShJpptrtg Name,K-ard Class,ID NLMber, <br /> Paddng Group and p(d any)) 10.Cora!ners <br /> No. 11.Total 12 Unfl <br /> o on RCRA hazardous waste, solid (Soaps, 1 Type 13.Waste Codes <br /> 5 otions), CF 00015 P 331 <br /> LU <br /> LUon RCRA hazardous waste, liquid (Soaps, 1 <br /> otions), DF 00125 P 331 <br /> 3. <br /> 4. <br /> 14spoualHa;tezV ,,�E.�,� ltn,°"�0n <br /> Liquids) 1. 110903(State Regulated Solids) 2. 110902(State Regulated <br /> 9 ted <br /> 15. GENERATOR'SICFFERORS CERTiflCATl M:1 here <br /> marked end tabe!ed/plaprded,and ara in a3 respects[n�deN.are that the w tangy a!Uus cashlnmen!e a Wy and acaaaay desrnbed above 9re <br /> E)pate,I oattiy that the confer a of thk Proper cend tion for transport acconf.'rg!o app0eab a Inama bnal arA monal proper sh rpuxl name are d <br /> !°artrTY that he waste mnsignlwt coalorm to the tams)`Ihe ailact d EPA gowmmenta regrdations.if ezpx!sfd <br /> mtraffon statamz d idem`ed In 40 CFR 2GLZ7 a d I am a of Co tser,L P+n-t am I am to primary <br /> Genera o sfO°erors Priat kffyped Name q�tify gene 2ror)or(b)(dl am a srnaA quarttygem2tor)fs tare. <br /> FJ- 16.Intemationel Sh,pmertls e P •t e Month Day Year <br /> z <br /> Transporter sura( ❑ImpertoU.S. ❑ from U.S. 09 24 019 <br /> it 17.Transporter� ) Port of enbylex't <br /> LU AdorovAedgMarl of Rece. t of Material Data Iear g U.S.: <br /> OTransporter 1 Pan ed7fyped Nana <br /> co Sig <br /> rn <br /> 2 r 2 ed/lyped Mane Month Day Year <br /> n <br /> 16.Discre i Month Day Year <br /> 16a. Indcatlon Space ❑ OuarEty ❑Type <br /> r' ❑Rash ❑Pa t1a Re eCJon ❑Full Re eC:on <br /> 6b,A'arrrale FacTty(or Generate Man!ell Re!ere xa Number <br /> U.S.EPAfD Number <br /> LL Fac3tys Plane: <br /> LU <br /> 18c S gnawre o!At�maa Fag dy(or Gene a or) <br /> 2 <br /> N19.Hazardous Wasfe Report M Month �y Year <br /> Lu ana9emer t Mo tod Codes(i.e coees far haze dors <br /> p 1. 2 ............ waste treatment,disposal,and re,yu;ng systems) <br /> l f + 3. <br /> V) 4. <br /> 20.f)eskl ra ed Fad 4 or operator:CertSptbn of receipt of hazardous materials covered by the man:rest <br /> Pr n ed/Typed Mame except as in Item 16a <br /> S+Ar>a'ara <br /> EPA Fom 8700-22(Rev.12-17) Previous ed tions are obsolete. CqY Year <br /> DESIG A D FACILITY TO EPA's e-M I FE YSTEM <br />