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RECEIVED BY SJCEHD (EF) ON 5/15/19 PI se print or type-(Form designed for use on elite(12-pitch)typewriter.) Foran Approved.CMB No.2050.4039 UNIFORM HAZARDOUS 1.Generator ID Number 2-Page 1 of 3.Emergency Response Phone 4- ni stM"6754 ackln Nu 6 WASTE MANIFEST CALOW4120M 140&-363--%M 7 7 5 4 J,J K 5.Generator's Name and Mailing Address Generators Site Address(If different than mailing address) SALLY BEAUTY SUPPLIES 010229 10710 TRINITY PKWY#C STOCKTON,CA 95219 Generator's PhoneROg-477'5385 6-Transporter 1 Company Name ll-S.EPA ID Number ALL CLEAN HAZARDOUS WASTE REMOVAL INC. CAD9024923W 7 Transporter 2 Company Name U.S.EPA ID Number TEMARRY RECYLING,INC- CAROOOI94217 8.Designated Facility Name and Site Address U.S.EPA ID Number RECICLADOI�A TEMARRY DEulEroca r4rac 130612001 CARRETERA FEDERAL NO.2 MEX SAN PABLO, TECATE 13C Facili 's Phone:619-27G-9!153 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11•Total 12.Unit 13.Waste Codes HM and Padting Group(if any)) No. Type Quantity wt.IVal- 1. 414- 4MT—L00015- 2. X31 -x@9'1 s� POW - x 3. UN3767,WASTE CORROSNE LIQUID,BASIC,ORGANIC,N.O.S.. 331 D002 (CALCIUM HYDRO)UDE,SODIUM HYDROADE),8,PG 11 i v 5- 4- 4- NON RCRA HAZARDOUS WASTE LIQUIDS.(DETERGENTS, _ 561 GLYCOLS) 14.Special handling Instructions and Additional information PRIMARY SORTER: TEMARRY RECYLING INC POUF A10383 3) R 1 (Bast=4air Prodrarr save) 4)R I Tft')-4Al (NRL-CP) Czs- a P ,! [I 6 15 GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the c ntents of this consignment are fully and accurately described above by the proper shipping name,and are Bassi ied,packaged. marked and labeleftlacarded.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 consign msnt conform to the terms of the attached EPA AcknoMadgment of Consent. I certify bat the waste minlmixation statement identified In 40 CFR 26217(ay(If I am a large quantity genera"F(b)(ifI am a small quantity generator)is true. XT 11 .. R"'T'r rqe IV L- SignaW 1 month +S� +Year J 16. terrationa +{L I4 �� F ❑Impart to U.S. Export from U-5. Port of entrylexit Transporter signature(for exports only): Dale leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintWyped Name Signature Month Day Year ZZ Transporter 2 Printedffyped Name Signature Month Day Year 2- /A �5 1e Discrepancy 1Ba.Discrepancy Indication Space ❑ Ouantlty ❑Type ❑Residue j ❑Full Ll Reaction Rejection Manifest Reference Number: 1ft.Altemate Fadllty(w Generator) U.S.EPA ID Number J U Facility's Phone: � 1 Be.Signature of Attemate Facility Lor Generator) Month Day Year 4 Z F, 19.Hazardous Waste Report Management Method Codes(I e..codes for hazardous waste treatment•disposal,and racyding systems) a 1 2. 4 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous mater.nks covered by the manifest except as noted in Item 18a Pr yped Name r• Signature Month Day Year I T EPA Form 8700.27(f2 .3-05) Previous editions ar0.ohsolete. DESIG NATO'FAC I LITY TO DESTINATION STATE (IF REQUIRED)