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Please print or Mm. 111111111111111 Fora Appviedl.OMB No.2O5O4M <br /> UNIFORM HAZARDOUS 1.Gerrerabr ro Nurrreer T2.Pepe 1 a 3.Em�encr ResPaW Phone 4.Maalerurracgrrg TauberWASTE MANIFEST AL000426099 775772669 1 1 9 9 FLE <br /> 5.Gerrerabfs <br /> Nm and Ab9 Addmn Gerreratafs SBeAddress(d diBereN 8rerr meRrrg address) <br /> I M1 <br /> Victoria' s Secret 1144 Victoria's Secret#1144 <br /> 094761963 4950 Pacific Avenue Space 425 <br /> � R 4950 Pacific Avenue <br /> GeneraWsPhone: Stockton CA 95207 Stockton C 5 7 <br /> mns=W I Canrpeny roma <br /> .s. Nmnber <br /> Stericycle Specialty Waste Solutions Inc MNS0001 4 <br /> 7. raMpaner 2 Company Name u s. ro Nr11 <br /> ardw <br /> WWOW CD s <br /> a.t7asignetee Faality Name and Site <br /> Add—Yuma Yes, ILLC J U.S.EPA ro Nuonber U <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Foal s RmnB286428938 <br /> ga. 9b.U.S.DOT Deeatption fmdWbv Proper Skip"Nam Berard Claw,ID Kerber <br /> HM and Paddrg (Harry)) N.Camebrerm 11.Tow 12.UNI <br /> No. Type Qaa* WAta1. 13 Waste CodeB <br /> on RCRA hazardous waste, liquid (Soaps, 1 <br /> otions), F 00089 P 331 <br /> W <br /> W � <br /> R7 <br /> 3. <br /> 4. <br /> 14.speamHm ,rgl'mlr'an°rm'Add!t" do—'-1. 110902(State Regulated Liquids) <br /> 15. OERERATOR'SIOFFEROR'S CERTIFCATION:i hereby declare Brat the=rob adds aro i*and aoaealey above by the proper d*phg name,and mrm .pedmpd. <br /> marked and WnledJ mated.so are in 80 reapecle in Proper condition for bamgwt eCoording to app<Gxbte kftr~ww g0vemrIrdll .g <br /> F VMK,I M*that the contents a this oonsVmwd=*rm to the WoN a are atleclred EPAAelmowledgnwd and I am the Primary <br /> I W*BW Da waste adN�tlon afmlemem Mmftd h,a0 CFR 21I2.27(m)(K I am a large qum tty generator) (b)(ill am a genermpor)is tnre. <br /> Gowaloer�rterare t rypea me RCL ro b e h a l f Of L i m i t e Mvnti Day ear <br /> =T-xPW*: <br /> rr-80-03vods"): <br /> s 07 19 0 9 <br /> ❑Ex wt Win U.S. a exit <br /> 17.TWWPD lerAdWwbdpWo1Reo*dMatW* rA U.S.: <br /> Transporter 1 yped Nenre —Z� <br /> o0. nthon Mack "font' Day Year <br /> TnnKporter2 yped Nemo 07 19 019 <br /> NA <br /> D" Year <br /> 18.Mscn ancy IQ- 1 <br /> 18a.Discreparraylrftdm Spece El E]7* ❑Residue ❑PWWR*Won ❑Fuit;t*dtian <br /> 18b.Altema%Faa'3y(or t3wwmlor) Marufeet IZefererroe Number <br /> U.S.EPA ID Number <br /> V <br /> Tai F.10 Phone <br /> W18c Somb le aakrrrmce Fadgty(or <br /> Day Year <br /> W19.Hararfts Waste RepM Menegronerd Meow Codes(e.,Codes for hmsdo re waste beont.dbposd and ) <br /> 20.Deaig,reaed Famay owrreror oPeramr Cerh7rrtoo a reoe0t a haomrdora nwfmmm oovered by the main except ass noted In Item lea <br /> C� rMonth Day Year <br /> EPA Form 8700-22(Rev.12-171 t'remus e0fim are obsolete. DE G ED FACILITY TO EPA's"AMFEST SYSTEM <br />