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i Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emerenc Res onse Phone 4.Manifest Tracking Number WASTE MANIFEST CALOOO426099 1 877977269 011434040 F L E 5.Generator's Name and Mailing Address Generator's Site Address(t different than mailin address) Victoria's Secret 1144 Victorians Secret#1144 2094761963 4950 Pacific Avenue, Space 425 4950 Pacific Avenue Generator's Phone: Stockton, CA 95207 Stockton, CA 95207 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions Inc MNSO 0110924 7.Transporter 2 Co pany Nam U.S.EPA LINumber 8.Designated Facility Name and Site Address cf I ST Century , U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone:775575?760 NVD98O895338 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. X 1UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 CF 00031 P 331 D01211 U0O2 Alcohol, Acetone), 3, PG II, ERG#128 Z 2. LU t9 3. 4. r 14.Special Handling Instructions and Additional Information 1. 110905(F 1 am mab 1 e Liquids) 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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generators/Offerors PdntedfrypFd NamSignature SRCL rep on behalf of Limits Month Day Year 1 061 0,21201111 16.International Shipments F— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter si nature for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day ear Isidro Martinez 061; 221P01 Trans o Prints d Na ont Day e FUrA.-- - z,,� 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: LO 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 L / 2. 3. 4./Ll 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Mon Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO S (NATION STATE(IF REQUIRED} 8700-22_12v3 C8293378 541067702 041119438 M PDO62218 SDO62218