Laserfiche WebLink
RECEIVED BY SJCEHD (EF) ON 11/7/2019 <br /> Please print or type.(Form designed for use on elite12-pitch <br /> ( )typewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1'(ienerator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST 008548530 FL E <br /> 5.Generator's Name and Mailingres, s re,s(if different than mailing address) <br /> Ulta Beauty #314Ulta Bear_lt'J#314 <br /> 209'2'351209 5-x10 Pacific Ave, 5410 Pacific Ave. <br /> Generators Phone: <br /> Transporter6. Company Name <br /> PA ihumber <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address General Environmental 1M q t, LLC U.S.EPA ID Number <br /> 11855 White `dock Road <br /> Fadiliry's Phase: Rancho Cordova, CA 95742 <br /> ga. gb.U.S.DOT Description(including Proper Stripping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.IV . <br /> o X 1UN1950, Waste Aerosols, [flammable, (each not 1 CF 00010 P 331 D001 <br /> exceeding 1 L capacity)] 2. 1, ERG#126 <br /> W <br /> UJI X 2UN1993, Waste Flammable 1 iquids, n, o. s. 1 CF 00020 P 331 D001 U002 <br /> (Acetone. Alcohol), 3, PG II, ERG#128 <br /> 3Non RCRA hazardous waste, liquid c^ DF 00306 P 331 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1. 102784 (Aerosols, Flammable) 2. 102792(Flameable Liquids) 3. <br /> 102788(State Regulated Liquids) <br /> 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, <br /> marked and labs ediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. g regulations.If export shipment and I am the Primary <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 am a small quantity generator)is true. <br /> orator eros PnnWTyped Name Sign a ure <br /> On Behalf of Ulta (E1 Sept DC on ay ear <br /> —J16.International Shipments <br /> d <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Z <br /> Transporter signature for exports only): <br /> � U.S.:17.Transporter Acknowledgment of Receipt of Materials Date leaving <br /> Transporter 1 Printed/Typed Name rgnature <br /> Month ay Year <br /> rn <br /> ranspoerPn coT <br /> ign rea I RA 039 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑ResidueEJ Partial Reaction ❑Full Rejection <br /> j <br /> t8b.Altemate Facility(or Generator) Mandest Reference+lumber: <br /> V <br /> U.S.EPA ID Number <br /> Q <br /> Oracill 's Phone: <br /> `y 182.Signature of Altemate Fa."y Or Generator) <br /> F� Month Day Year <br /> •g.Hazardous Waste Repos Managenront Method Coder(i.e.,codes for hazardous waste treatment,die <br /> poral,and recycling systems) <br /> 20 Designated Facility Owner or Operator:CertiNca 14 <br /> Art# y Name tion df receipt of fi s mat#rials*Wdf#d by the manif#at#xd#pf as ndta(1 in Item ttia <br /> • Ign <br /> � ay oaf <br /> FPA Form 87oo=22(Rev.3 0�) previous editions sfft Cbsojet#, 2 <br /> DESIGNATED FACILITY TO ESTiNATiON STATE(IF REQUIR <br />