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Please print or <br /> 1.Generator tD Number Form Approved.OMB No.2050.0039 <br /> UN(> Us 2 Page,of 3.ErtergertcRespprye Ph" 6 9635 FSE <br /> wAsre I+aaNlFesT <br /> 6.G me orad Naeng Address Genararofs Stts Addrow(d d*nmd hark ma&g a kbm) <br /> Bath 8 Bodv Works 65 <br /> Bath & Body Works#65 <br /> 099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFIC AVE <br /> Genorebfs Plmne <br /> 6.Transporter 1 Company Name <br /> U. .EPA ID Nurraber <br /> Ste S' <br /> 7.TmnspwW 2 Canpany Name ' a i <br /> U.S.EPA tD Number <br /> Gc.U/t-t�wi�e - vUE-v ysr�s C}E�� �5Y Z <br /> 8 Dew"mFamyNam andme AftmYuma Yes, LLC U.S.EPA IDN=bw <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Face eam-42AS42893A 107RORI91 199P4 <br /> g0- 9b.U-S,OOT Deaafpson Qts Proper%d*q Name,Hazard Casa,ID Mm dw,, ,0.C caeca 11.Tatra a <br /> FIM and�C-9 T a 12.Un <br /> ny)) N0. i7Pe y WUt d 13.Wass Codes <br /> fin RCRA hazardous wast*, liquid (Soaps. 1 F <br /> otions) 00168 c 331 <br /> u�5 2 <br /> ca <br /> 3. <br /> 4. <br /> u'speUMm,de,Vlm 6m>,andAdkonWIrto,", 0"1. 110902(State Regulated Liquids) <br /> i6. GEN9tATOR'BfOFF>atOR'S C�ATtON;I �`� " ��2 <br /> herebydeder9 iht the oorrtenb ori Qris 0atsigrartard oras fatly and amua�ly dearnLed by the MW tl9*q name,and are dauNW,padopq. <br /> �'rrated a�a0 respects in proper oorad6on for traroport a=&q to&*p c bla ftneft and rntloraal rtrgt oras 0exporl sh(p, d ero I sen the Pnrraaly <br /> aorNam to Sae tam=d the attached 6'AAdaaAedgmerd d <br /> I mtly tlaet the w=*adrdtrtratloaa statemerd Ideraled in 40 CFR 282a(a)(a I ran a lerpe WZY Or )(0I a-A generator)b trate. <br /> ftib <br /> r�rye C r e us. n elf a f L i to i t s Moi°' Yea< <br /> 1:1�to 07 <br /> ❑ from U.S. Pon of 26019 salt <br /> Trm,P«w dgrtabde(for e>grorh only): u.s� <br /> u.Tra„apormrAd ad m1cfR*0an <br /> Trartaporter 1 Rbttsdliyped Name r Der Year <br /> nthon Mack <br /> y T 2 yped N/em/oMDO Day Year <br /> 18.Dnaepancy , r�✓'C lot { <br /> 180-.DscreplarKy trdica6on Spada D Y ❑Type ❑f7 ❑Par6al <br /> ❑Rr0 Re;BcBon <br /> 19b.Akmafe Fml! (or Generator) Alardhest Rsferenoe Number. <br /> U.S.EPA(D kmnber <br /> v <br /> LL FaaMA Phone: <br /> 0-w 1 %Fmhaa of AWntaW Fac tty(or Generator) Morten Day Year <br /> X <br /> W19.h�tdous Waste Report WhOd Codes a*..00493 W hazardous vm%treatr=;4 diapoeat.and mcyc&V systema) <br /> C 1. 2 3. 4. <br /> 20.Designated FwRy Omer ort)p,a ,,Ce ft—abon d recetpt of dazerdmm nastm wmad by Ire manuesl mmW as n*d h Item 8s <br /> EPA Forth 8700-22(Rev.12-17) Previous edr5aas are ab�lefe. <br /> DE IGNAT F LITY TO EPA's e-MANIFEST SYSTEM <br />