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i <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response one 4.Manifest Trackin Number <br /> WASTE MANIFEST CAL000426099 1 8775772669 010 8 8997 F L E <br /> 5,Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Victoria' s Secret 1144 Victoria' s Secret#1144 <br /> 2094761963 4950 Pacific Avenue, Space 425 4950 Pacific Avenue <br /> Generator's Phone: Stockton, CA 95207 Stockton. CA 95207 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Addr s "Jist Lentury"Jig EMN, LLU U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone: 7755752760 NVD980895338 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> X1- UN1993, Waste Flammable liquids, n. o.s. (Ethyl 1 CF 00027 P 33 D001� U00' <br /> Alcohol, Acetone), 3, PG II, ERG#128 <br /> I <br /> 3. s <br /> 4. <br /> 3 <br /> 14.Special Handling Instructions and Additional Information 1. 110905(F l a m■ab 1 e Liquids) <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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 m a small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Ngrrp 6ignature Month ay ear <br /> PDatd. <br /> ep "bef of Limite <br /> 0 0 201 <br /> J 16.International Shipment <br /> 1-- ❑Import to U.S. ❑Export from U.S. en 'exit: <br /> Z Transporter si nature for exports only): vin U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> Transporter 1 Printed/Typed Name Signature Month Day ear <br /> Johnny Harper I 0d 0d 201 <br /> zTransporter 2 Print yped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> L) <br /> Q <br /> � Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> U) <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> 0 <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESkGNT=11)�IACUTY TO INATION STATE(IF REQUIRED) <br /> 8700-22_12v3 C8293378 541067702 041011578 M PD010918 SDO10918 <br />