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Pleqse print or type,(Farm designed for use on elite(12Otch)typewriter. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response one 4. an Is Tracking Humber <br /> WASTE MANIFESTCALIRM11M - 12 408-391-MM 015886662 J J <br /> 5.Generator's Name and Mailing Address Generator's 5teAddress(if different than marling address) <br /> SALLY BEAUTY SUPPLIES 8752 <br /> 678 N.WILSON WAY,M91-33 <br /> STOCKON,CA 95205 <br /> Generator's Phone 209-941-0255 <br /> 6.Transporter 1 Company Name U.S-EPA ID Number <br /> ALL CLEAM HAZARDOUS WASTE REMOVAL INC. CA0962492399 <br /> 1 7,Transporter 2 Company Name U.S EPA ID Number <br /> TE HARRY RECYLMIG.INC. CAROOD19421T <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> RECICLADORA TEMARRY DE MEXICO M�OC:3os 19001 <br /> CARRETERA FEDERAL NO.2 MEX <br /> SAN PABLO. TECATE BC <br /> Facilitys Phone: 619-270-9453 <br /> ga 9b.U-S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt Nol. <br /> X 1 UNI 9W,WASTE AEROSOLS(EM No EXC@eMng 1 L Capw", f 331 DOD 1 D035 <br /> FLAMMABLE.N.O.S..2.1 <br /> X 2- UNI WASTE FLAMMABLE LIQUIDS.N.O.S.,(ACETONE. a 331 D001 0035 <br /> ISOPROPANOL),3.PG It F003 <br /> x s' -8c*- B8e <br /> II <br /> em— <br /> NON <br /> m -NON RCRAHAZARDOUS WASTE LOMS,(DETERGENTS, 1 561 <br /> GLYCOLS) r" <br /> 14.Special Handting instructions and Additional Information <br /> I)RRO91513 E� 1 >c5�r i msel ) PRIMARY EXPORTER: TEMARRY RECYLNG INC PON 10941 <br /> sfa 4)R 1 �(NRL-CP) <br /> 15. GENERATOR'SIGFFEROR'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 Iabeled+placarded,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 <br /> Exporter.I certify that the contents of this consignment conform to the terms of 11re attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quanifty generator)or(b)(if I am a small quantity generator)is true. <br /> Ge W-'Offergrs Pr ntedffyped Name nature 1111111 Da Y r <br /> \0" (J <br /> A <br /> 16,International Shipments ryry�� <br /> 171Import to U-S. LJ Export froml7.5. Port of entryfexit <br /> Transporter signature(for exports only) Date leaving U-S.: <br /> 17-TranspiorterAcknowledgment of Receipt of Materials <br /> 11- <br /> Cr0 <br /> Transporter rint fi areC Signature F�gth Day Ye r <br /> CL <br /> QTransporter 2 Pdntedffyped Name Signature Month Day Year <br /> 16.Discrepancy <br /> Toa.Discrepancy Indication Space ❑ Quantity ❑TypeAll Residue Partial Rejection ion Full Rej <br /> ection <br /> Manifest Reference Number <br /> ISb-Altemate Facility(or Generator) U-S-EP <br /> U <br /> rdi Facility's Phone: <br /> LLI 18c.Signature of Alternate Facility(or Generator) Monlh Day Year <br /> H <br /> 4 <br /> Z <br /> 019.Hazardous Waste Report Management Melnod Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) 7 <br /> 0 1. <br /> 20.904ated Facility Owner or Operator:CefiScari plot hazardou$materials covered by the manifest excel5t as noted in <br /> PnNr7�0 <br /> ped Name Signature Month Day Y cur <br /> c �7 <br /> o0 22(Rev. -0 Previouseditions cur o sofete. DESIGNIAT AGILITY TO DESTINATION STATE(IF REGlUIF{ED) <br />