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Please ' tor <br /> •(Form designed for use on elite(12-pitch)fypewter.) <br /> 1.Generemr ID Number Form ed.OMB No.2050-0039 <br /> UNIFORM HAL4Rp0US 2.Psge 1 of 3.Emergency Response Phone �.Man at T <br /> WASTE MANIFEST. CAT000610949 2 (80(7?.3 6--1221 7712WAS <br /> 7,WT�VALAiCORQAl7—SiTEN PEF�EZ } i� V fB3a11}AN PEREZ <br /> TRACY, CA S5?76 40p WEST VALAICO ROAD--SITE <br /> (209}836-1971 TRACY CA 95375 <br /> GenaralWs Phone: BEN: 4495 <br /> company Name <br /> HERITAGE TRANSPORT, LLC f SIGNAL HILL U.S.EPA IVNumbar <br /> IND058484114 <br /> 7.Transporter 2 Cofnperry Name <br /> U.S.EPA 10 Number <br /> 8.Dr11Ma t WNTAL SERVICES LLC U.S.EPA ID Number <br /> COOLIDGE,, 9Z 8E STOREY 5228 AZD081705402 <br /> Fedfly's Phone: (520)723-4167 .. <br /> ga, 9b.U.S.DOT Description{including Proper Shipping Nance,Hazard Class,ID Number <br /> 10.Containers11.Total 12.Unit <br /> }{M and Paddng Group(If any)) No. Type Quantity MAW. <br /> Waste Codes <br /> X 1' RQ,UN1950 WASTE AEROSOLS FLAMMABLE, D(701� ._.... <br /> N.(].5. ,2. 1, {�AINT), (D0t�1),E�tG*126 513� � 2� <br /> �+ X 2' RG NA3077 HAZARDOUS WASTE SOLID !/ <br /> � 9,P6II I, {NER�URY}, (D009),ERG�171 ' N. •S• , DO0 <br /> T <br /> 3' NON RCRA HAZARDOUS WASTE SOLID (OILY <br /> ABSORBENTS) <br /> 4. 1I p�y lav <br /> NON RCRA HAZARDOUS WASTE SOLID (OIL 221 <br /> FILTERS) Die <br /> 14 Spq�L _XA T y rr)m xsq <br /> Ips�nsa Z5 DP_ <br /> nMll IQ258 9 LDR ,3.W2 0532299 4,W3 053c� 0 <br /> ry <br /> 1139053436T <br /> 15. GENERATOR'S MEROR'S CERTIFICATION: f hereby dedare that the contents of this conslgmnent are fully and accurately described above by the proper shipping name,and are desaft.packaged, <br /> marked and labeled,00carded,and are in all respects in proper condition rortransport aoconding to applicable International and national govemmentalulations,K <br /> rag export shipment and I am the Primary <br /> I cardfy that the contents of this consignment conform to the WItts of the attached EPAAdmowledgment of Co nt <br /> certify prat the wade minimization statement identirred in 40 CFR 262.27(x)(01 am a large quantity generator)or(b) all qua generator)is We. <br /> Name rgM'y year <br /> MZ <br /> L"1 V <br /> IF internedonal SNomen <br /> ❑Import to U.S. ❑Export from U Port of entrylexlt <br /> T Wr exports only): Cale lwAna U.S,: <br /> 17.T ment of Receipt of t 21-6 <br /> 11 erne / Sign Month Day Year <br /> ransportar2 Pdnwffyped Me L C� are V 0, NERM Day 79—u-- <br /> 18.Dwepancy <br /> 18a.ownpamy Indication space Quantify ❑Type ❑Residue ❑Partial Rejection ❑FUN Rejection <br /> Manifest Reference Num r. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> Fadi' s Phone: <br /> 11 signature ofAhemets Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 r H141 2 H141 P- <br /> H141 4 H141 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br /> PrintediTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. ;3ESIGNArED�17AGILI 171 TO IUESTINATION STATE(IF REQUIRED) <br />