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204244- 1554 <br /> r�Rl <br /> ILL OF 1.QRemr's ID Number Page 1 o1 3.Ert�argeuy Response Phone N <br /> A1*M I — <br /> , me and Meiling Address Offerors SIM Address(If different than maRN address) <br /> TIN, INC. (020—TRACY) / DAN PEREZ TIN, INC (#020—TRACY) / DAN PEREZ <br /> 400 WEST VALPICO ROAD—SITE 400 WEST VALPICO ROAD—SITE <br /> TRACY, CA 95376 TRACY CA 95375 <br /> offerors Phone: (209)836-1971 GEN: 94495 <br /> B.Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company ame U.S.EPA ID Number <br /> B.Dm*VwMd Facdlly Name and Site Address U.S,EPA ID Number <br /> HERITAGE0 ENVIRONMENTAL SERVICES LLC <br /> 284 E AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> Fed Phan: (ciPn)722-41 A7 <br /> 9a. 9b.U.S.DOT D,,dpd n(including Proper Shipping Name,Hazard Clava,10 Number, 10,Containers 11.ToMI 12.Unk <br /> HM and Packing Group(if arty)) <br /> No. T Quantity W1.NoL <br /> 1. <br /> I <br /> (U , 4 a3 V <br /> 2. <br /> JBIRY <br /> 991441 i Allf 1"AWATMA46-3 11-114 44)QR&X-H7C- <br /> x SOL , ' <br /> 3. <br /> o NON—DOT UNIVERSAL WASTE—MERCURY CONTAINING LAMPS <br /> W <br /> 4. <br /> NON—DOT UNIVERSAL WASTE—MERCURY CONTAINING LAMPS <br /> i P r <br /> 5. <br /> NON—DOT/NON--RCRA REGULATED .�vf <br /> B. <br /> 7. <br /> 13.Special Handling InstmOons and Addiifaral Information <br /> 1.W 14 0275945 2.W15 0532319 3.W 16 {?532317 4.W17 (2532378 5.W19 (2259558 <br /> I Cr-xs P-r �1 a opo <br /> 14. OFFEROR'$CERTIFICATION: I hereby declare that the contents of this oonignnrsnt aro My and a=m*desalbed above by the proper shipping name.and are dassified,packaged, <br /> marked and labeledlplacarded,and are in all me"in proper condition for transport eckxrclrg to appBcabb in and naborw gmemnwq regulations. <br /> Otlerors PrirrtedlT Na <br /> Signature Month Day Year <br /> LAI 7 <br /> 15.T Adrrwwledgment of Receipt of <br /> i Tra typed Na on Year <br /> Transporter PrintedlTyped Name nort" monm May Year <br /> 16.Discrepancy <br /> F 17.Designated Facility Owner or operator:Certification of receipt of hazardous Bill of LadingAlanfMst covered by the manifest except as noted in item 16 <br /> PrintedlTyped Name Signature Month Day Year <br /> } Y � ' DESIGNATED FACILITY TO OFFEROR <br /> ,... <br />