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Piease pr:.nt or type. <br /> 1.Gene ator ID Number Fcrm Approved,OMB No.2O50-0039 <br /> UNIFORM HAZARDOUS 2.Pafe 1 cf 3.Emergercy F.asponse?hone 4.8ianifest TnekiNumber <br /> WASTEMANIFEsr CAL 000427614 1 8775772669 0121§62805 FLE <br /> 5.Generators Nana and Mailing Address Genzratai s Site Address,if dii'erent than maairg addrs;j <br /> Bath & Body Works 65 Bath & Body Works#65 <br /> 2099524396 5308 PACIFIC AVE, SHERWOOD MALL/ SPACE 6 5308 PACIFIC AVE <br /> Generators Phone: STOCKTON, CA 95207 STOCKTON, CA 95207 <br /> E.Transporter 1 Company Namz <br /> ii 5 e?A iD Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> Trarsporier 2 Company Name <br /> U:_EPA to Number <br /> Worldwide Recover S stens CAR000175422 <br /> 9 Designated Facility Name and Site Address - <br /> Yuma Yes, LLC a S.EPA ID Number <br /> :730 E. 13th Street <br /> Yuma, Az 85365 <br /> ra.�iay';Phone: <br /> r 3 azR000515924 <br /> a 9a <br /> U.S.D:;T Descnphl .iincl•,dmg P-ocer Snrocing NaTe.Haza:d Clas; lO dumber <br /> Lim aro Pactm3 Group(.any)} jr!a ver; 1' ctal 12.Unit 13.:;'aste Codes <br /> Type uuanhry Aarlrci <br /> w Non RCRA hazardous Waste, solid (Soaps, i 1 DF 00087 P 3?, <br /> Lotions), <br /> W <br /> z 2 <br /> W <br /> z <br /> i <br /> 14 S�Eciai i'andlirg!cstnr,;rycns and Addii:erai Infcrmatinr <br /> 1. 110903(State Regulated Solids) <br /> 15 GENERATOR SiOFFEROR'S CERTIFICATION:I neeby -clare!hat 1f•e nt •s of thisTrmenl ar ally a to cu atzy desc bed cbaYe by the pial i FF` a Ja d are etassified,packaged. <br /> e•read a d o la?iplac rd d,arc -re r a�1 resp rs r orccer mnd1on for-rarsP0rl ac ofei v 7 app- n.en•a-ior_lanc naronal re vernmanla+reg;;laears.d excon shipmem and i air. p- <br /> tz�cr;er. n:r, Jr3i i r_nts of hi Cors;gnr enf rT C.n t,the cars-f ft atlacned E?AA•,arcN.e.gmerl Ct r15enL the 6rmart <br /> �eriy that Ine+taste mre R-zaticri talement oe ufied e 40 CFR 262 271-1i t f am a avge anh: rneratcr; - l- <br /> s au i 9- �r t, f 1 am a;matt quanfry,gine aMr,is the <br /> Ge e,t^rs' Nei rs onntec;Typrd me Signature <br /> ,repo ehaIf f Lim ite Month Day Yea <br /> •j i"c.irter.. oral Shipments i — 02 27 201 <br /> F-• • impart b U.S. L;i Expo i from U.S_ Per of entry <br /> TranspCttef signature;icr expors ctiy, -- <br /> Da'e lear;rg U.S.. <br /> W 17 tfanspcner Fcanay.Jeeome-t of Receipt of Mat_ra!s <br /> -:ansoc.ver'Pr,r!ecr`T cad Name <br /> 4 Signature Von!r <br /> Day Year <br /> Z0�o sop 2Prnted!'a.c-'V,me p <br /> Q - - Riga, e- 07 201 <br /> k4omh Day yea• <br /> 16.J:sC•'epafty <br /> 183.Discre ar.;, ina.,-w _ <br /> P ! ..a:-:^nsoar� --�71 - <br /> Quantity T;:-e <br /> tiefe- <br /> ;ull Rzh.ct;o. <br /> Adlcrr2 d Fact q <br /> t r,^t•, a Ger.-r,• idanlf�t Rehr nue Nc.b=r- <br /> U S.EPA 10":u ober <br /> U <br /> LL Fau'ays?h--e <br /> W 18,Sig* <br /> alute C' teml:= abtity Cr a, ralcri <br /> z Jeclh Day Year <br /> 1."azafdcus V':aste Rzccrt n3geMEn-'aihcd Codes crates r•, <br /> ri.e.. I <br /> lL •r t:azar;, :pasta trealme"r,d�so..ai.an.^.•acycting sy�rs: <br /> O � _ <br /> l . I20.Designated Faciiiry owner Cr Dpera cr.Ce,VCalty of recei„of hazardous materials co <br /> .ered by Ole maritest axcep as r;,;'ed rrnlod iypedN m n+tem is6a <br /> Sgna ufe <br /> R'rn1h Da yea <br /> EPA-'Cr 87n-0-2 rP,ev ; rev nus editions are obsciete- � _ <br /> D-',IGN i ED FACILITY TO EPA's e-MANIFEST SYSTEM <br />