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Please print or We. Form designed for use on elite 12-pitch) writer.) Form Approved.OMB No.2050.00; UNIFORM HAZARDOUS 1 Generflfor 10 Number 2.Pegs 1 of 3.Emergettcy Response Phone 4.Man"' WASTE MANIFEST CAT004G 10949 1 (800)326-1221 =7713WAS I� ,gN�l� RACY) / DAM PEREX G�'F'I4 ,sit i ress�( !b feF) DAN PEREZ 400 WEST VALPICO ROAD—SITE 400 WEST VALPICO ROAD—SITE TRACY, CA 95376 TRACY CA 95376 (219)835-1971 GEN: 94495 6.Gernerators Pltate: ransporter 1 Company Name U.S.EPA ID Number HERITAGE TRANSPORT, LLC f SIGNAL HILL IND058484114 1,TransWrtar 2 Company Name U.S.EPA ID Number 1.Dedft— g U.S.EPA ID Number 2000 N. ALAMEDA STREET CAT080013352 COMPTON, CA 90222 (310)537-7100 Fad a Phone: 9b.U.S,DDT Description(including Proper Shipping Name,Hazard pass,ID Number, 10.Containers 11.Total 12.UnH 13.Waste Codes Nmand Pad�9 P(ti y)) No. Type Quantity MAW, 1' NON RCRA HAZARDOUS WASTE LIQUID (USED OIL) 22 7 V '7 ! Z 2, 3.• 4, 14 fp"Mons and Additional Information 11 [1390506]GT 15, DENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare lhatthe contents of this consignment aro fully and accurately dewired above by the proper shipping name,and are dassilfed,packaged, marked end labeled/placarded,andare in all respects In proper condition for transport seconding to applicable inWnationaland national govenarnenlal regglations.V export shipment and I am the Primary Exporter,I certify that the contents of this cwmignment conform to the leans of the a1ffiched EPAAdmowledgrnent of Con"if. I cm*that fits waste minhrdzWon statement idendlfed in 40 CFR 262.27(a)(If I am a Idrga quantity generator)or )(K)o apol quaMl nerahor)is true. ns re _r J 18,InleirMillonal Shipments ❑Import to U.S. ❑Export from Port of entrylexit: T nature far onl �kly); Date leaving U.S.: 17.T Ardmowledgment of Receipt terials 44 gna re aer IC `P ca Tnmapoder 2 Pd Name na ure ear 18,Discrepancy 18a.DlaCrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number v u- FadW Phone: 0 Ilk Signature of Altemate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method as(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4. 20.Designated Faciftfy Owner or Operator:Certitfcaliori of:receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed!ryped Name Signature Month Day Year EPA t=orn 9700.22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO tOESTINA i';e},) ;�;if E SIF tEt UTAEO)