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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 CAD000633032 1 (800)321-8842000137228WAS <br /> 5 GTpIr,(4MTa,C"1ddrRODUCTSLLC / MICHAEL PETE RSlJergfor' itT <br /> roe nt"OdWil LLC / MICHAEL PETE <br /> 2700 WEST WASHINGTON STREET 2700 WEST WASHINGTON StREET <br /> STOCKTON, CA 95203 STOCKTON CA 95203 <br /> (209)466-4407 GEN: 120604 SURVEY: 91099 <br /> Generators Phone. <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC—COOLIDGE IND058484114 <br /> 7.Transporter 2 Company Name US EPA ID Number <br /> 6 De�s�ate�Farjljty�a fearui$p ,d esLNTAL SERVICES LLC US EPA ID Number <br /> f81t512t 15�NE38TH <br /> 1 STREET MOD981505555 <br /> KANSAS CITY MO 64161 <br /> Facility's Phone (b 16)453-4321 <br /> ga. 9b.U S.DOT Descnption(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12 Unit <br /> and Packing Group(if an ) 13.Waste Codes <br /> HM 9 y) No. Type Quantity WLNoI. <br /> 0: X 1 RQ UN1993 WASTE FLAMMABLE LIQUIDS N.O.S. , 4 DM 2580 P D00 D00 D008 <br /> 0 3 PGII, (GASbLINE/BENZENE), (D009 D00� ), <br /> E4G#1281 (4x55gDM) D009 D018 34 <br /> w <br /> Z 2. <br /> W <br /> i <br /> 3. <br /> 4. <br /> I <br /> i <br /> 4.I pttHapoljnp,I1s�ujtisns and di iirif Information 14 <br /> W 4i ti 1 11242250313T <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and aca.ately described above by the proper shipping name,and ane classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable internatiorwland 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 ib)(if I am a small quantity generator)is true <br /> Generatorerors Printl Name , signature on ay ear <br /> /�- S 1 f/u-yll / dill <br /> J 16 International Shipments <br /> H ❑Import to U.S ❑Export from U S P .of ntry/exit <br /> Transporter signature for exports only). D eavin U S <br /> Li <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter t Printed/Typed Name ignatuMonth ay Year <br /> a <br /> Z Transporter 2 nnted/Typed Nall Signature onlh Day Year <br /> t- <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Q <br /> Facility's Phone. <br /> W 18c.Signature of Alternate Facility(or Generator) Mi Day Year <br /> Zz <br /> F) <br /> N 19.Hazardous Waste Report Management Method Codes(i e.codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1H061 2 s a <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> �8 101 <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. D IGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1 - - 1q <br />