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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.Em"ency Response Phone 4.Man'rfest Trac ' u be WASTE MANIFEST CALOD0411� 2 40 363.3678 O 1 L 9 4 7 JJ K 5.Generators Name and Mailing AddressSALLYDUTY SUPPLIES*752 Generator's Site Address(it different than mailing address) 678 N.WILSON WAY,08-33 209-941-0= STOCKON,CA 95205 Generator's Phone: 6.Transporter 1 Company Name ALL CLEAN HAZARDOUS WASTE REMOVAL INC U.S.EPA ID Number CA09624923M 7-Transporter 2 Company Name TEMARRY RECYLING INC U.S.EPA 16 Number CAR000194217 8.Designated Facility Name and Site Address RECCLADORA TEMARRY DE MEXICO U.S.EPA ID Number MMC 130613001 CARRETERA FEDERAL NO.2 MEX SAN PABLO, TECATE BC 519-270-9453 Facility's Phone: ge. 9b-U-S.DOT Description(induding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13 Waste Codes HM and Packing Group(Ran y)) No. Type Quantity Wt-Not. 1. FLAmMA9LE,N.O.S.,2.1 z2. . ISOPROPANOL).3.PO it 1 GLYCOLS) C)ff 497 14.5 eci I yand1i Instructions and Additional Information �) 0916 3 Ira (APIT1601)(5 L) IMARY E}<PORTER: TEMARRY RECYLING INC PON A10383 2)R 1 2 A (FUM Z_s r3TP r 4)R 1689"�e4 y (NRL-CP) L5-4;tt to) 15- GEN ERATOR'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, 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 of the attached EPA Acknowledgment of Consent. i rerhfy that the waste minimization statement idenfiNd in 40 CFR 262.27(a)(91 am a large quantity generator)or(b)cif I am a small quantity generator)is true. era1&s1Offeror'5 Print Name Signatu 1 onlh Day Year S. r _.1 16.International Shipments ❑lmpat to U.S. Export from U.S. Part of entrylexit: _ _} Transporter srgnature(for exports only): Date leaving U.S.: 117 Transporter AcknoWedgment of Receipt of Materials Uj Transporter 1 PrintedlTyped Name Signature Month Day Year e 20- Transporter 2 Pnnted(Typed Name atur Month Day Year A ;A/ L rA12 r - 18.Discrepancy 18a-Discrepancy Indication Space ❑ puan' trty 171 Type L1 Residue ❑Partial Rejection Full Rejection Manifest Reference Number- 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U I Facilitys Phone: W 18c.Signature of Alternate Facility(pr Generator) Month Day Year a x cn 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) W }. 2. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the man#est except as nqlad M Rein 16a ff PrinledfTyped Name _ Signature - Montt Day Year EPA Farm 8700-22(Rev-3-05) Previous ed iton sW6 obsolete- :fieSA9ATED FACILITY TO DESTINATION STATE(IF REQUIRED)