Laserfiche WebLink
Please print or type.(Form designed for use on elite(12-1 typewriter.) Form Approved.0i No.2050-0039 <br /> UNIFORM HAZARi 1.Generator 0 Number 2.Page 1-171 <br /> Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000411327 1 408-363-3678 017 3 6 7 0 7 3 JJ K <br /> 5,Generator's Name and Mailing Address Generator's Sate Address(if different than mailing address) <br /> Sally 5cauty Supplies * 752 578 N WILS0N WAY $ h-33 <br /> 17574 COLIMA RD STOCKTON, CA, 95205 <br /> RCIWd.AND HEIGHTS, CA, 91745 <br /> Generator's Phone: -70q 441 -tl?Afl <br /> 6 Transporter 1 Company Name U.S.EPA IO Number <br /> ALL CLEAN HAZARDOUS WASTE REMVAL INC <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> MIARRY RECYCLING INC_ CAR000194217 <br /> 8,Designated Facility Name and Site Address U.S.EPA ID Number <br /> RECICLADORA TEMARRY DE MEXICO <br /> CARRETERA_ FEDERAL NO- 2 IEY, SAA PADLO TECATE 15C <br /> Facilrtys Phone, 619-270-9453 0619001 <br /> 9a 91h.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any(} No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1. UN1950, WASTE AEPOSOLS (Each No Enceedinq IL D001 D035 <br /> p X Capacity) , FLAMLAISLE, H_O_S _, 2-1 ( � P — <br /> a 1 33 <br /> LLI <br /> z 2 U81993, TASTE FLAIML"LE LIQUIDS, N-0-S, D001 D035 €003 <br /> (ACETONE, ISOPROPANOL) , 3, PG II �F tC) p <br /> 3� <br /> 3. UN1479, WASTE 0XIDIZING SOLID, N_O_s _ , D001 <br /> (POTASSIUM PERSULFATE, SODIUM PERSULFATE) , (( G � � P <br /> a <br /> 5 -1, PGIII <br /> 4. NON RCRA HAZARDOUS WASTE LIQUID , <br /> (DETER—GENTS—GLYCOLS) r 1� p 6 <br /> 14.Special Handling instructions aditio Information �XZa <br /> 1) 8093.613 /10 EAezasol) 2) R /2A—(Flaw Liq) 3) R / ) --(OK.ic i'rer) <br /> 9) 6t J Gtr 1 t!!"Ri.-CP) 1`rsali-k) <br /> PRIMARY EXP0RTER: 'TEMARRY RECYCLING INC. PD# J-1-90 <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 classed,packaged, <br /> marked and labeled)placarded,and are in all respects it proper condition for transport according to applicable in ational and national governmental 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 EPAAcknowled ent f Consent. <br /> I cern at the waste minimization statem t identified in 40 CFR 262.27(a)(if I am a large quantity gene or( 0 <br /> i('rf I am a small lily generator)is true. <br /> Generar, Day Year <br /> V2� <br /> -J 16.1 ema io al hipmen s <br /> t- ❑Impo to U.S. Export m U.S. Port of entryfexg:� AsS. 1C( <br /> Transporter si nature for ex orfs only): Date ieavin U.S.: <br /> W 17.Trans er Acknowledgment of Reoeipt oft&erials <br /> 1- Transporter TrintedfTyped Name Signature Month �DDayy Year <br /> a ✓�-�� I l <br /> Q Transporter yped Name �� Signature Morlith Day Year <br /> t]G 44- � <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity <br /> ❑Type Residue Partial Rejection EJ Fuil Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Faciiity(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rat Facility's Phone: <br /> LU 18c.Signature of Aitemate Facility(or Generator) Month Day Year <br /> to <br /> a <br /> z <br /> 19 Hazardous Waste Report Management Method Codes(i e,codes for hazardous waste treatment,disposal,and recycling systems( <br /> LU 1. 2. 3. <br /> 20. ignated Facility Owner or Operator:Certification oTt of hazardous tedals covered by the manifest except as noted in Item I8 <br /> Ph e�Typed ame ( Signature Mon ay Yea1rm (Rev.3-0 revious editions are obso DESIGNATED FA I DESTINATION STATE (IF REQUIRED) <br />