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RECEIVED BY SJCEHD i ON 5/15/19 <br /> Please print or type (Farm designed for use on elite(12-pitch}typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator lD Numberage 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL0004120M �° + 408-363-3678 015884491 JJ K <br /> 5-Genarator's Name and Mailing Address Generators Site Address(if different than maiiing address) <br /> SALLY BEAUTY SUPPLIES 910229 <br /> 10710 TRINITY PKWY#C <br /> STOCKTON.CA 95219 <br /> Generator's Phone <br /> 6.Transporter 1 Company flame U.S.EPA 10 Number <br /> ALL CLEAN HAZARDOUS WASTE REMOVAL INC. <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> TEMARRY RECYLING INC. <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> RECICLADORA TEMARRY DE MEXICO MXC130619001 <br /> CARRETERA FEDERAL NO.2 MEX <br /> SAN PABLO, TECATE SC <br /> Facility's Phone: <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(if any)) No, Type Quantity Wt.Nol. <br /> 1. <br /> X UN1950,WASTE AEROSOLS(Each Na Exceeding 1 L Capaelty), I 1 331 Di D035 <br /> Q FLAMMABLE,N.O.S.,2.1 <br /> LL <br /> LL <br /> X 2 U11i WASTE FLAMMABLE LIQUIDS,N.O.S.,(ACETONE, ,fes 331 Di D035 <br /> ISOPROPANOL),3,PG If 11 r <br /> rtaas <br /> i{ 3 <br /> UN 1479,WASTE OADONG SOLID,N.O.S.(POTASSIUM 141 D001 <br /> PERSULFATE,SODIUM PERSULFATE),5.1,PG 10 1 (, <br /> 4_ NON RCRA HAZARDOUS WASTE LIQUIDS,(DETERGENTS, r Q 561 <br /> GLYCOLS , C <br /> 14.Special Handling Instructions and Additional Information <br /> 1) R091613 I Of (Aerosol) PRIMARY EXPORTER: TEMARRY RECYUNG INC PO# A11440 <br /> 2) R I ( lam LIq) <br /> 3) P_12!01 Ja4-TD(Oxldtzer) 4)R I li Mvilli(NRL-CP) <br /> 15. GENERATOR'S)OFFEROR'S CERTIFICATION: i hereby declare that the contents of this consignment are f y and'accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeiedlplacarded,and are in all respects in proper condition for transport according to applicabi intemati nal and national govemmental 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 EPAAcknowledg ent of nsent. <br /> I certify that the waste minimization statement identified in 40 CFR 282.27(a}(if 4 am a large quantity generalo or(b)(' m a small quantity generator)is true. <br /> 'nt dlType�yl@me'�'ff7 Signature � Day year <br /> 2 1 , <br /> 1 16 Vtomalional Shipm nts <br /> i ❑Import to U.S. ®Export from U. . Port of entrylexlt _ <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> LU 17.Transport cknowledgment of Receipt of Materials <br /> � Transporter 1 ed Name Slgnature Month Day Year <br /> O Zlo <br /> a <br /> QTransporter 2 PrintedlTyped Name Signa Mo 4,' Day Year <br /> �---� C- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> Fes-- 18b.Alternate Facility(or Generator) U.S-EPA ID Number <br /> U <br /> nai Facility's Phone: <br /> w 1 Sc.Signature of Atemate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> rn <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 /> S <br /> T? <br /> 20. esig ated Facility Owner or Operator:Certification of ecelpt of hi mate Is covered by the manifest except as noted in Item 18a <br /> Prind ped Name Signature Month Da� Y <br /> AIN\V" <br /> EPA Form 22(Rev.3-0 evious editions are ob tete. DESIGNATED FAL7110 F7110Y TO DE TINATION STATE (IF REQUIRED) <br />