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It i <br /> . ��IEf�1��Il�llll�l��ll�ll ! f� llll�lll �� <br /> Please print ortype. Form Approved.OM5 No.2050-0039 <br /> UNIFORM HAZARDOUS42 Page 1 of 3. boric 4.Manifest Tracking Number <br /> WASTE MANIFEST 16133 012496360 F L E <br /> 5.Generators Name and Mailing A16,T <br /> t 68-ier—ateillits Address(if different than mailing address} <br /> Beauty 1152 Ulta Beauty#1'152 <br /> (209) 368-2115 1423 South Lower Sacramento Road 1423 South Lower Sacramento Road <br /> Generator's Phone: Lodi, CA 95242 Lodi, CA 95242 <br /> 6.Transporter 1 Company Name U,8,EPA ID Number <br /> Stericycle Specialty Waste SolutionsIncM W CqZ 01 O Im I I j7h, 24 <br /> 7,Transporter 2 Company Name S.EPA ID Number <br /> Worldwide Recovery Systems ICAROOL4175422 <br /> 8 Designated Facility Name and Site Address y u m a Yes, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Faciiiny's Phone-9286428938 IAZROO 515924 <br /> 9a, gb.U.S,DOT Description(including Proper Shipping Name.lHazarc!Class.lD Number aI <br /> HM and Packing Group(if any)) 12 Unit 13,Waste Codes <br /> Wt AM <br /> Non RCRA hazardous waste. solid (Consumer I110 P 331 <br /> 0 Products), <br /> Z ;Non RCRA hazardotui �iaste. liLiuid (Consumer 00058 <br /> LU ail <br /> Products), <br /> 4 <br /> 14.Speciall Handling Instructions and Additona� <br /> L '�`rmaw` 1. 11211a789(State Regulated Solids) 2. 102788(St at e Regulated <br /> Liquids) <br /> 15. GENERATOWSIOFFEROR'S CERTIFICATION: I"by declare that the contents of this consignment are fully and*Jately described above by the proper shipping nOre—aril ofe s fed,packaged, <br /> marked and labiefeWptaurded,and are in al respects in proper condition for transport according to applicable interna anal and national governmie.ritat regulations,if export shipment and I am m <br /> ' 9 1 the Primary <br /> Exporter,I certify that the contents of thus consignment conform to the terms of the ancheo EPA k sell <br /> !certify that the waste minimization statement identi din40CFR26721(a)(iflemaiapepva,)tityge.mrI I tc,)0,fbi(, irr,a sinal!qjant-#generator)is true <br /> Genera led(Typed NaMA Signalure - V I __ <br /> 01 lit half of U ' Exce t 0 rDay "ear <br /> _j 16.Intamafioral Shipments <br /> Import to U.S. �Export from U.S. wort ofentryiext! <br /> Tra,rsporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transportc,Acknovoiedgment of Receipt of Mater,UJI <br /> rX Transporter I Printedirtyped Nam® <br /> Signature <br /> Kristopher Almanza Month, ray Year <br /> CL t3 28 019 <br /> Name <br /> Month Day Year <br /> 18.Discrepancy,, <br /> 183.Dis y indicator.Space ❑ <br /> Quantity type lResidue 0 Partial Rejection Fu,,4elect*­ <br /> 18b.Alternate Facitily(or Generator; S EPA!D Number <br /> Facility's Phone, <br /> u0i 18c.Signature of Alternate <br /> Month Qay Year <br /> 19-HMAIOUS Waste Re,-.:-: <br /> LLJI Method Codes�11 e,codes to;hazardous waste treatment,disposal,arid recy <br /> 0 2. ng systems) <br /> L't <br /> 20. wnurorOperator Certification of receipt of hazardous materials covered by the rparb <br /> Ptinled(Typed Na test excel) ed in item 18a <br /> Signature <br /> tont Year <br /> EPA Form 8700_22(Rev.12-17 Previous editions are obsolete, 9 <br /> DESIG 'EI FACUTY TO EPA's e-MANIFEST SYSTEM <br />