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i <br /> Please print or type. I <br /> INS H1 11111111111111�11 Forrr <br /> Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.�enera;cr ID Number 2 Page`o1 =m?r,g t.y Rasponse Ph:r e 4.Mani?st r m N b <br /> WASTE MANIFEST I' X12192903 FLE <br /> CAL0+�D04C7614 1 F1775T7�669 <br /> 5 Generato?s Na n-.and M-Ora A.ddr>c; G erat Sd,•Vcrass,rt here!Iran mailing 2ddt?5Sr <br /> Bath & Body Works 65 Bath R BodY Warks#65 <br /> 2099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPA C 6 5308 PACIFIC AVE <br /> Genera!oesPlone: STOCKTON, CA 952017 STOCKTON, CA 95207 <br /> 6.Transporter 1 Company Name U.S EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc IMNSOOOII0924 <br /> '-espnner 2 Company Name U.S EPA 10 Number <br /> Worldwide Recovery Systems CAR000175422 <br /> 9.Designated Facd:fy Nacos an!SaeAddress Y ll Ql d Yes, LLC U.S EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facih:y s Phone:9286428938 <br /> 9a. .U S.COT Cescriplion(nolo",rv;°roper Si,i p!^a Name"laud Cias . D'�J..,,":ee•. ^,ainers ,,1� <br /> and°dGlc? (i:au 1` <br /> Hi.1 >9 p:.ary% : loo Uni <br /> Typ, Quantity Vt Arc1. 13.4Vasle Codes <br /> 0 Non RCRA hazardous waste, solid (Soaps, lij F + 01143 P 31 <br /> otions), <br /> Z <br /> Z <br /> UJ <br /> Non RCRA hazardous waste, liquid (Soaps, 1 � F 00005 P s'sl <br /> Lotions), — <br /> 3 <br /> d. <br /> i <br /> I.I.Special Ha;aIng Instructioi,s ora Addi!ionat Ir.',n+.a!icn <br /> 1. 110903(5tate Regulated Solids) 2. 110902(State Regulated <br /> Liquids) <br /> qq <br /> 15 GEN ERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare iki!the c:rterts.,l•-is c:,rsig;cit a are tui y an;; j.^•ura r;y descnbed ab^.v!by the prone'shipping rave.and are cats-`ed.packaged, <br /> marked ana Iabe'ediplacarded,and are n alt respects in proper corlLftor ter trar-sp^".rt accomirg!a r-at:-at,r-;ernmeatal rag::!at,ons.!export sripme^t and I am the Primary <br /> Exporter.I cerlit trial the c^ntents of this cons gnment confcrm to the terns cl the a!!acttee EFA A,;r cw edgmen!of sen; <br /> t.cer,.fy that the waste minimization statemen identified.n 6:1 CFR 262 27a)0;am a Barge q,antq gererarcrnr ibj i.i I n sear Gua�uty generator)is true. <br /> ria^eralcr';•'OHa_rcr's°;;nted�Tveyd t•:`nN 5 crzatury 1 110- Day Year <br /> 2__ _ `xdRGL �^e tin--� a�f—o F--L i m i t e <br /> .International Shipments <br /> �- maaa t%U S 2zt_r,from C 5. Pcr.of en;ry:2xa <br /> Z -ransponer signatory!Tor ax n-,nrAyi <br /> LC ?z.Tran-^t;;'r^rAdr❑,i I Date Mavf^g U.S <br /> W a. -v edasere of Rece�p:;;r hgatena!s ; <br /> � Tmnspoder 1 Pr:ntedrTyped Name Sn7:�au:re <br /> 0 Month Day Year <br /> L J— <br /> n. °'WSJ G�-•z�.-�— �"'�_ •__.---' <br /> Z n t• ! yp c <br /> 3:g^aiu•e �.. h y <br /> 18 Discrepancy <br /> 1 H Discrepancy lndfcationSpace (I''`11 I�I <br /> L- Quantity ��Type ❑Re Nue Partial Rejection ❑Fu8 Rejection <br /> tlamtesl Reference Numbs <br /> 1db.AiernateFau:itylc:Generator? U-S.'cPA,0Number <br /> U <br /> LL Faci:ity's Pt:one. <br /> w 18c.Signature of Aite na!e Fac�ity(or(3enerator) McMh Oay Yaar <br /> Q <br /> Z <br /> N <br /> +.g.Hazardp Waste Repan,M1laragemenl'dethodC—les(i.e.,codes for hazardous waste!reatntyr;,disposal,and ecyclinq list ms)LU 1 2. 3 <br /> 2G Cesiy,ra'ed Facility Owner or Cperator Certification of receipt of hazarddus materials covered by the manifest ex:;ept as tdin Item 1 Ba <br /> Printed yped Name <br /> Sig acre <br /> - nln Day a r <br /> EPA Form 87DC-22(Rev ?2.17) previous editions are obsoly!e. ESI FD FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1. <br />