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Please clef or type. Form A roved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1'Cen ID Number 3S 2.Page 1 of 9@0rek5�18346 Phone an eet rec ng um er <br /> WASTE MANIFEST O FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if differ@nt Ilan mailing addre'�s <br /> Ulta Beauty 1152 Ulta Beauty 152 <br /> (209) 368-2115 1423 South Lower Sacramento Road 1423 South Lower Sacramento Road <br /> Lodi, CA 95242 Lodi, CA 95242 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Steric cle Specialty Waste Solutions Inc MNSOOOL10924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Worldwide Recovery Systems CAR000175422 <br /> 8.Designated Facility Name and Site Address Yuma Yes, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facility's Phone: 9286428938 <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 /> ''Non RCRA hazardous waste, liquid (Consumer 1 DF 00114 P 331 <br /> Products), <br /> Uj <br /> W 2Non RCRA hazardous waste, solid (Consumer 1 DF 00093 P 331 <br /> Products), <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information 1. 102798(State Regulated Liquids) 2. 102789(State Regulated <br /> Solids) y� <br /> 15. GENERATOR'SlOFFEROR'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 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the 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 quantity generator)or(b)(ill am a small quantity generator)is true. <br /> Generator'slOfferor's Printedrryped Name Signature On Behalf o tExcept DC Month Day Year <br /> 61 20 201 <br /> 16.International Shipments <br /> _j Import to U.S. <br /> ❑ Export from U.S. Part of entrylexit: <br /> Z Transporter signature(tor exports only): Dale leaving U.S.: <br /> X 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Printed/Typed Name MOMILI Day Year <br /> a Kristopher Almanza 06 1 20 201 <br /> z Transporter 2 Printed/Typed Name Sig nalu Month Day Year <br /> VQIL10("1 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantityype <br /> ElT ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> u- Facility's Phone: <br /> in <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. K t T <br /> LA1 3. 4. <br /> -Mk20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except gk noted in Item 1 Ba <br /> Printed/Typed Name Signature Month Day Year <br /> (D_j+A11t1 C&QCA)l102, I W� INT 12 11q_j <br /> EPA Form 8700-22(Rev.1 -17) Previous eddion are obsolete. I t,1TF11 rACILITY TO FPA's e-MANIFEST SYSTEM <br />