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oral Approved-OMB No 2050-0039 <br /> PleaSe Phi"I or type. 1.Genefalff ID Number 2,par 1 Of ,Emergency Response Phone 4,Man est Trs4ldag Number <br /> UNIFORM HAZARDOU DILOQ2 LE <br /> WASTE M IFEST CAL000426099 i 8775772669 _F <br /> 5 Gene &a Name;7d Mailing Address b Ad*eos Cd diftrent than Maying XWMSS) <br /> Victoria' s Secret 1144 Victoria' s Secret#1144 <br /> 2094761963 4950 Pacific Avenue, Space 425 4950 Pacific Avenue <br /> r'enerawes Pho, Stockton. CA 95207 Stockton. CA 95207 <br /> G 2L U.S,EPA I D NjmV-f <br /> &TrOASO&W 1 Company Name — '�7cR —pho- <br /> AN 7 6 9 <br /> �7 <br /> t'e�� <br /> S74 dMerent than <br /> Stericycle Specialty Waste Solutions Inc <br /> 7,77a_nsporter 2 Coff Vany Name U.S,EPA 10 Number <br /> t e_,d&Qn61UVFZ- <br /> t <br /> T,_[*sIgw*FXMyWWir_dS#eAddmsS Yuma Yes, LLC U.S,EPA ID Nanbor <br /> 2730 E. 13th Street <br /> FadWsPhone: 9286428938 Yuma, AZ 85365 GZRO A515924 <br /> oa9b.U.S.DO.T Desuotim(moluding Prom SWpirg Name,Hazard fuss,ID Number, 10 Containers 11.Total 12.Uri: 13.Waste Cmes <br /> HM and Pa*ing Grow fit any)) TYPE! QuanW Maw, <br /> iCF 00012 P 3all <br /> Non RCRA hazardous waste, liquid (Soaps, <br /> Lotions), <br /> ...................A- <br /> 4, <br /> 14 SWaal HardeV lnSVUV00M and AdditionM fiftfOM000n 1.110902(State Regulated Liquids) <br /> UA <br /> 15. GENERATMSWIFEROR'SCEIMFICATION:I hereby declare drat ftonntonts of hs consignment am"and dftabel above by the proper shipping name,and". da%!W,packnod, <br /> marked and labeledAptaurded,and am In al reSPOM M MW condoon tni transport accordlrg to aWica!A oftmationaland national govemmootal rogjalions.If export shipment and I am ft Primary <br /> EWW,I CenIfy that the eontenLg of#*WnSignMent CWOFM to the wrm of U aWted EFAftwiviedtIment of consent. <br /> I certify that the w4ste mirom4ation statement ideaVW In 60 CFR 262,27(a)(if I am a"quantflY generator)Of(b)(iff am a Small W30generator}llstrue„ <br /> PrintedfTyped Name Signa tureSFtFL -t-e--WAIh ---Day year <br /> I 1 04 ji 2A19 <br /> I- L Imps! U.& EW from U.S. Port of entry/0,41: ........... <br /> 16.International Sh"rft <br /> M <br /> 10 <br /> Transpoft si9n0a(for eVOM-K__ Date W"U.S: <br /> 0: 17,Trwaporler A*Vwleonem Of Receipt of M010" <br /> Tmmpotter I P*Wnyped NaM6 Signature rg;,h Day Yo* <br /> 0 <br /> _;.4—her Alsanza I t 04 1 1 aylig <br /> Day Yaw <br /> cans rp&2 NntedfTy Name <br /> ;14 L;2y CAVO <br /> 16. <br /> 18a,Disore�Wim6on Spa,,- 0 Nanfity ❑Type El R.&. Partial R.IWInn 0 Fell R.10%. <br /> Mamla3t Reference Nurnbor. <br /> 18h Aftemale,FwMy(Or Gertomtor) U.S.EPA 10 Number <br /> u. FacAlys Phone: <br /> %nature of Alleroate Fadlity for Generator) rAn'O' Day I Year <br /> 19.Hazard=Waste Report Management Megwd Codes 0A.,0oft fCK hAZWOUS*2W treats ti,d$PGWI and fecicfirg Systems) ]4� <br /> Uj <br /> 20,Designated Fadq Owner or Operate:Ce0cationdreceipt ofhazardous maters comodby ftmar lImtexcept as noted in Bern 18a <br /> PrinlWy*Nam SignatUra Gib Day Yp"I' <br /> EPA'"A422(RevM12-17) Previous editors are 0SdBt&- D NATER FACUTY TO EPA*s e-MANIFEST SYSTEM <br />