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RECEIVED BY SJCEHD (EF) ON 10/28/19 N4u Wf � Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST _ 008548530 FLE 5.Generator's Name and Mailing Ad r ""`' ';';M f 71eAd rE (if different than mailing address) Ulta Boluty 1,1314 Ulta lioil y"i311 2Q92351�199 a�?Q P'3 f is Ave. 5410 C Ave. Generator's Phone: nw. Fi .-.�_ nn 6.Transporter 1 Company Name "`" -' 'EPA'iD Number 7.Transporter 2 Company Name M _ "" ' -"" U.S:EPAID'Nurri-- 8.Designated Facility Name and Site Address U.S.EPA ID Number C,ener�i k=nvlrnna�nial91;s I+C 11855 +,lhite Rocky Rvnd Rancho Cordova, CA 957+4c ' Facility's Phone: q ,ry mqn nmA nn i.i n,2 ga. 9b.U.S.DDT Description(including Proper Shipping Narne,Hazard Class,10 Number, 10.Containers 11.Total 12 Unit ~ HM and Packing Group{if any)) No. Type Quantty M A(ol_ 13.Waste Codes o X FUN-1950. t-t-Iste Aer o:iolS, Iflall3ablP, (eL-ich (let, 1. C!= 00010 P A31 DOW e%evediny 1 L cdpaLi.ty)] 2. 1, E1104126 LUX zIIN1993, baste Flar;[j tble liquid,, n, o. s, 1 Cr- 0€GA2p P 331 D001 UIobR (PT-Ltor1C, Alcohol), M, PG 11, 1=RM1,128 3. Non RCRP ha--wdou; wAtstc, liquid R DF �Wlla P 331 4, 14.Special Handling Instructions and Additional Information I. 102784(kt-orals, F1 a2itiable) Liquldf,) 3_ ` 1052788(13;:atc Regul<atc�-; Liquids) I 15, GENERATOR'SlOFFEROR'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, marked and labelediplacarded,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 consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(d I am a small quantity generator)is true. Generatoesl eror'snntedffype Name igna re on ay Year r On 13e1rali aP Ulf:t. ( t,Pt Du LCT— J 116,International Shipments Z ❑Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature for ex As on!y): Date leaving U.S.: w 17.TransporlerAcknoWedgment of Receipt of Materials I.- Transporter 1 Pnntedrryped Name Signature n ay ear a CL ., r u. QTrbns rlef2 Pridte 1Tj*pe Name ignatUre 4rlth - r t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Futl Rele t. Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S,EPA ID Number v a LL Facilil s Phone: U, 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z 219.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ G 1. 2. 3. 4, 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedffyped Name Signature Month Day Year I EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNMED rACILITY TO GENERATOR STATE(1F REQUIRED) f I