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I�IINIIHIIIIVIIN�II��aI�N�I�IIN�N Please print or type. ERIC Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000426099 1 (877) 577-2669 014905175 F L E 5.Generator's Name and Mailing AddressAt t n:Jody Terrell Generator's Site Address(if different than mailing address) Victoria' s Secret 1144 Victoria' s Secret#1144 2094761963 2 Limited Parkway 4950 Pacific Avenue Generator's Phone: Columbus CO 43230 52 6.Transporter 1 Company Name U. .EPA ID Number Steric cle Specialty Waste Solutions 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address 2Is t Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone7755752760 1NUDqA0Aq97,7A 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt./Vol. X N1993, Waste Flammable liquids, n. o. s. (Ethyl 1 DM 00099 P 331 0001 0002 Alcohol, Acetone), 3, PG II, ERG#128 z Z 3 LU i 3 u 4 14,Special Handling Instructions and Additional Information 1. 110905(F 1 am mab l e Liquids) 15. GENERATOR'SIOFFEROR'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. Generator's/Offeror's Printed/Typed Name Signatur Month Day Year behalf of Limite �- ro ' 07 11 0- 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: x 17.Transporter Acknowledgment of Receipt of Materials w Transporter 1 Printed/Typed Name Signature Month Day Year COL Isidro Martinez 107 109 4020 5E Transporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space Quantity El Type El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z S219.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 ILA I 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Print NWInk ped Name - Signature Month Day Ye 1 w- -7 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DES( ATED FACILITY'TO EPA's e-MANIFEST SYSTEM 8700-2212v3 08293378 S41067702 041811640 M PD070920 9W7lRgP0