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Please print or type.(Form designed for use on elite(I2-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFESTCAL00041 1327 01 r- 886986 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address V different than mailing address} <br /> SALLY BEAUTY SUPPLIES 9752 <br /> 678 N.WILSON WAY,#Ell <br /> STOCKON,CA 95205 <br /> Generator's Phone.209-941-0258 <br /> 6.Transporter 1 Company Name US EPA ID Number <br /> ALL CLEAN HAZARDOUS WASTE REMOVAL INC. CAD982492399 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> TEMARRY RECYLING,INC. CAR000194217 <br /> d.Designated Facility Name and Site Address U.S.EPA ID Number <br /> RECICLADORA TEMARRY DE MEXICO MXC130619001 <br /> CAFRETERA FEDERAL NO.2 MEX <br /> SAN PABLO, TECATE BC <br /> Facility's Phone:619-270-9453 <br /> ga, 9b.U-S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Totai 12.Unit <br /> HM and Packing Group(.if any)) No. Type Quantity WI.NoI, 13.Waste Codes <br /> 0: X 1' UN 1950,WASTE AEROSOLS(Each No Exceeding ILCapaell 331 D001 D035 <br /> 0 FLAMMABLE.111 21 -- <br /> w X 2. UN1993,WASTE FLAMMABLE LIQUIDS,N.Q.S.,(ACETONE, 331 0001 Ell <br /> ISOPROPANOL),3,PG II <br /> fF003 <br /> X 3. UN1479,WASTE OXIDIZING SOLID,N.0-S.(POTASSIUM 141 D001 <br /> PI_RSULFATE,SODIUM PERSULFATE),5.1,PG III <br /> 4. NON RCRA HAZARDOUS WASTE LIQUIDS,(DETERGENTS, tJ <br /> .� 561 <br /> GLYCOLS) --�-- 4----- <br /> 14.Special Handling Instructions and Additlonai Information ` <br /> 1) 8091613 I J� ( `� � (Aerosol) PRIMARY EXPORTER-. TEMARRY RECYLING INC PO# 11132 <br /> 2)RI Flam II <br /> 3) R 1 l kat (OAdlizer) 4)R I '' st L'h (Nill <br /> 15, GENERATOR'S10FFEROR'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 Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental reguialions.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 EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a large quantity generator}or(b)(if I am a small quantity generator)is true. <br /> Ge ratorsfofferors PdntediTyped Name Sign ure - Month Day Year <br /> N-eX i <br /> J 16.International Shipments <br /> t- ❑Import to U.S. ��� Export from U.S. Port of ent ylexit <br /> Transporter signature(for exports only}: - - A-�` Date leaving U.S.: <br /> w 17,Transpo Acknowledgment of Receipt of Materials <br /> IIITransporter 1 in d Name Signature Month Day Year <br /> a <br /> ti L <br /> Z�[ Transporter tedlTyped Name Signat a Month Day air <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity Type Residue Partial Rejection Full Rejection <br /> ALt*tTIDeCilr T Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S. <br /> U <br /> ua. Facility's Phone: <br /> 1 Bc.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> N19 Hazardous Waste Report Management Method Codes('L codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 V�Ly 2. 3. 1dlJ � 4 �I��•S <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PdritedTyped Name Signature J�f/ Month {Day Year <br /> r'l u U' �Sl.i.�� r.- �I ��l 1Lt 1 r✓� i 9 1 I:F <br /> EPA Form 8700-22(Rev.3-05) Previous editions hire obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br /> L_ <br />