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IIIIIII�I NIII�III��N1 �Nl��l��l� <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000427614 1 877577,2669 012485943 FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Rath & Body Works 65 Hath & 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 /> 6,Transporter 1 Company Name U.S.EPA 10 Number <br /> Steric cle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Nam U.S.EPA ID Number V 139'1 F <br /> 8.Designated FacilityName and Site Address 21 s t Cent ur y EMN, LLC U.S.EPA 10 Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone: 7755752760 NVD980895338 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol. 13.Waste Codes <br /> X 1UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 *RW 00176 P 331! DO01 (U002 <br /> 0 Alcohol, Acetone), 3, PG II, ER13#128 <br /> r 1 <br /> w ` <br /> ,z X 2UN1950, Waste Aerosols, [flammable, (each not 1 CF 00003 P 331 D001I <br /> exceeding 1 L capacity)] 2. 1, ERG#126 '--� <br /> r <br /> 3. <br /> t <br /> i <br /> 4 r s <br /> t <br /> 14.Special Handling Instructions and Additional Information 1. 1 10905(Flammable Liquids) 2. 110904(Aerosols, Flammable) <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name.and are classified,packaged. <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifl m a spall quantity generator)is true. <br /> Generator's/Offeroes Printedrryped Name Signature SSRC on behalf of L i m i t e Month Day Year <br /> 02 01 201 <br /> 16.International Shipments <br /> r ❑Import to U.S. LJ Export from U.S. ort of enlrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> OC 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> � <br /> Transporter 1 Phntedrryped Name Signature Month Day Year <br /> COL Jeff Hamilton I 02 1 01 1.2on <br /> co Transporter 2 Printed/T ped Name SignatureIV Month Day Year <br /> e� DZ -210119 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity El Type L1 Residue Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rai Facility's Phone: <br /> W18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 11 <br /> D, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p t. A 2. 't^ l 3. 4. <br /> 20.Designated Facil`liiity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Ye <br /> �' ---- <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 8700-2212v3 C8293378 S41067816 041292116 M PD020119 SD020119 <br />