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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMR No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CALOOD411327 1 408-363-3678 1 017 3 6 7 3 7 5 JJ K 5.Generator's Name and Mailing Address Generators Site Address it different than mailing address) Sallyy Beautyy Supplies i 752 678 H WILSON WAY i 13-33 STOCKTON, CA, 95205 Generator's Phone: 700 0411-t19FiR 6.Transporter 1 Company Name U.S.EPA ID Number ALL CLEAN HAZARDOUS WASTE REMOVAL INC C 7.Transporter 2 Company Name U.S.EPA ID Number TEMARRY RECYCLING, IHC_ CARD00194217 8.Oesi noted Fadl'dtyy Name and Site Address U.S.EPA ID Number RELUICLADOBA TEMARRY DE MEXICO CARRETERA- FEDERAL NO. 2 MEX, SAH PABLO TECATE BC Facillys Phone: 619-270-9453 ffiCI30619001 ga, 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(fani No. Type Quantity WtNol. 1. UMILYOU, a o aacee D001 D035 331 q IL P � Capacity) , FLAMMABLE, H_O_S_ , 21 QO � K z 2. -O-S. _ D001 D035 F003 X (ACETONE, ISOPROPANOL) , 3, PG II 1 (1} _ / / P b 331 3. , R.O.S . D001 141 Y (POTASSIUM PERSULFATE, SODIUM PERSULFATE) , 1 ^ P 5 -1, PGIII l l ` 4. 561 (DETERGENTS .GLYCOLS) 1 IP 13 14.Special Handling Instructions and td nation 1) 8091613 //fl erosol) 2) R /L�(Fla1e Liq) 3) $ / �I (Owirilaer) PRIMARY EXPORTER- TEMARRY RECYCLING IHC- POA 12225 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping new,and are class,re4 packaged, marked and labeledlplacarded,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 AAcknowledgmenl of Consent. I certfy that the waste minimization statement identified in 40 CFR 28 a)(f 1 am a large anti generator or(b)(If I am a small quantity generator)Is We. Gen torst0feror's Pdn dNam Signa MonthDay Year "iii) I !� r'3 �7 16.In m h nal hipment IIppII El import to U.S. 111 Export from U.S. Port of e= S0 Transporter signature(for exports only): Date leaving U.S.: Z-Z W 17.Transporter Acknowledgment of Rai of atelots Transported edlTyped Name Sgnature Month Day Year Tramspi Prindid Name ^� Signatu m Day Year } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pamal Rejection ❑Full Rejection Manifest Reference Number. 18b.Altemale Facility jar Generator) U.S.EPA ID Number J U LL Facillys Phone: 44 18c.Signature of Alternate Facility(or Generator) Moran Day Year 2 H19.Hazardous Waste Report Management Method Codes(i.e.,cedes for hazardous waste treatment,disposal,and recycling systems) C 1. 2. 3. 4. 20.Designated Facility Owner or Operator.Codification of receipt of hazardous materials covered by the manifest except as noted in Its Pdntedrryped Name Signature Month Day Year Rve 1 1 EPA Form 8700-22(Rev.3-05) Previousediflons Ire obsolete. DESIGNATED FAdiITO DESTINATION STATE (IF REQUIRED)