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�Illlllllllll�� <br /> Please print or type. Form Approved,OMB No,2050-0039 <br /> UNIFORM HAZARf]OU5F' GTner_ajor kQ Number 2.Page 1 of 3.Emergency Response phone d.Man' st Tra//c In N mbbee�nn11 C eWASTE MANIFESTL�004 6099 71577 bGSI F1 til V FLE <br /> 5.Generator's Name and Marling Address Generator's Site Address(if different than mailing address) <br /> Victoria' s Secret 1144 Victo,•ia' s Sec:rer#1144 <br /> _:.0947619Et 4950 Pacific Avenue, Space 42"'J 4950 Pacific Avenue <br /> GeneratoesPhone: Stockton, CA 95207 Stockton, On 95207 <br /> Transporter 1 Company Name U.S.EPA ID Number <br /> _,v; icycle Specialty Waste SolutionInc 441600 c : i24 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Worldwide Recovery Systems ICARNO1754___. <br /> 8-Designated Facility Name and Site Address U■a Yes, LLC U.S.EPA ID Number <br /> F-730 F_ 13th Street <br /> Yuma, A7 85355 <br /> Faoilily's Phone?C��+'iC_�9.:�; Z kfa!01i85 1 594 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(it any)) No. Type Quantify Wk.Not. <br /> IZ azardoua waste, liquid <br /> 1on5) , <br /> Q <br /> LU <br /> LU <br /> a 12. <br /> LU <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information :. 1109 d@ R e g it I at e C L i g U 1 d 5 <br /> 15. GENE RATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the owtents of this consignment are fully and accurately described a by the proper shtpping name,and are classified,packaged, <br /> marked and labeledfplacarded,and are in all respects in proper condition for transport according W applicable internationa national gove menu[regulations.If export shipment and I am the Primary <br /> Exporter,l certify that the contents of this consignment conform to the terms of the atached EPA Admow edgment of Ca ent. <br /> I certify that the waste mmim0tion statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) am a s all quan g orator]is true. <br /> Gen r51Offeror's PrintedlTyped Named_ 5ignaYu , 1'r: - f' :]" # OT l_; .' l Month Day Year <br /> 16.me national Shipme <br /> ❑Import to U-S. Export from U.S- Port Of ' <br /> exlt: <br /> ? Transporter signature(for exports only}; Date le g U.S.: <br /> ck: 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Printedlryped Name 5' to Month Day Year <br /> Anthony Lack 12 I1 - <br /> 2 Trans r 2 PrintedrTyped Mame � � Sig � Month Day Year <br /> L ►4 <br /> 1 a.Discrepancy <br /> 18a,Discrepancy Indication Space Quantity ❑Type ❑Res due. ❑Partial Rejection ❑Full Rejection <br /> •S <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> L.1 <br /> t4i Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month DayYear <br /> a <br /> 2 <br /> 19.Hazardous Waste Report Management Method Codes(i,a.,codes for hazardous waste treatmem,disposal,and recycling systems) <br /> � <br /> I 2. 3• 4 <br /> 6L1 <br /> 20.Designated Facility 6wner or Operator:Certification of recelpt of hazardous malerials covered by the manifest except as nut yd in Item 18a <br /> Prtnted7yped Name4bm <br /> Month Day Year <br /> U 0-- 1-1 <br /> EPA Form 8700-22(Rev,12-17) Previous editions are obsolete. DESI VIOD FACILITY TO EPA's e-MANIFEST SYSTEM <br />