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RECEIVED 2/15/2019 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved OMB No 2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000411715 1 405^363-367$ 017 4 0 3 0 9 5 J J K <br /> 5.Generalor's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> SALLY BEAUTY SUPPLIES#1:1679 <br /> 1163 S.MAIN ST,SPACE A-4 <br /> 1WANTEGA,CA 95337 <br /> Generators Phone;09-824-1064 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ALL CLEAN HAZARDOUS WASTE REMOVAL INC. CAD982492399 <br /> 7,TransporteT 2 Company Name U.S.EPA ID Number <br /> TEMARRY RECYCLING,INC. CARD00194217 <br /> 8.Designated Facility Name and Site Address RECICLADOIRA TEMARRY DE MEACO U-S,EPA ID Number <br /> MXC130619001 <br /> CARRETERA FEDERAL NO.2 MEX <br /> SAN PABLO, TECATE SC <br /> Faci ily's Phone: 619-270-9M <br /> ga 9b.U.S.DOT Descnption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13-Waste Codes <br /> HM and Packing Group(N any)) No. Type Quantity WWol. <br /> X 1 UN1950,WASTE.AEROSOLS(Each No Exceeding 1 L CapaCIM, .331 D001 D035 <br /> o FLAMMABLE,N.O.S.,2.1 <br /> � 1J1 <br /> L }{ 2 UN1993,WASTE FLAMMABLE LIQUIDS,N.O.S.,(ACETONE, I n 331 D001 D035 <br /> ISOPROPANOL),3,PG II r r t f ram <br /> }( 3 UN1479,WASTE OXIDIZING SOLID,N.O.S. (POTASSIUM 1n 141 D001 <br /> PERSULFATE,SODIUM PERSULFATE), 5.1,PG III <br /> 4 NON RCRA HAZARDOUS WASTE LIQUIDS,(DETERGENTS, <br /> GLYCOLS) <br /> 14 Special Handling Instructions and Additional Information 4 <br /> 1) R091613 1I0.� (Aerosol) PRIMARY EXPORTER: TEMARRY RECYLING INC PON A12980,#140 <br /> 2 R [am LIM <br /> 3� F �c (CWditr) 4)R ! 11ol It K a (MRL-CP) <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 classified,packaged, <br /> marked and labeledlpiararled,and are in all respects in proper condibon for transport according to applicable inlematlonaland national governmental regulations.If export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAeknowledgment of Consent. <br /> I oerllfy that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity gen o I am a small quantity generator)is true. <br /> !;WOffe&s PdntedfTyped Name Sjnatu Month Day Year <br /> roc m iNl Anez, -1 a"1 <br /> 16.International Shipments <br /> ❑Import to U.S. Export fmm`b.tPort of entrylexd: <br /> z Transporter signature(for exports only): Date leaving U.S.: 1 <br /> W 17.Transpo er Acknowledgment of R of Matenals <br /> a Transporter tedTryped N Signature Month Day Year <br /> O <br /> a <br /> Z Transport r 2 Printedffyped Name 5lgralule Month Da Y ar <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity, ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> 3 <br /> u <br /> Facilitys Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> US19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 3. 4. <br /> �J <br /> 20.D hated Facility Owner or Operator.Cerfification of reoei t of hazardous materials covered by the manifest except as noted in Item 18a <br /> Print Name Signature Month Day Year <br /> J U <br /> EPA Farm 8700 22(Rev. 05) Previous editions are obsolete. DESIGNATED F ILI TO DESTINATION STATE(IF REQUIRED) <br />