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(Fr�trtt: eSI rleo for use on ellte(12-pitch'typewrite <br /> HAZMAT BILL OF I,Cfferors ID Number page 1 of 3.Emergency Response Phone 4.7racking Number <br /> LADING MANIFEST 2 <br /> 5.Offeror's Name and Mailing Address Offeror's Ste Address(if different than mailing address) <br /> TIN, INC. (020—TRACY) i DAN PE:REZ INC (#9J20—'FRAM') f DAN PERE? <br /> 400 14EST VALPICD ROAD—SITE 400 WEST VALPIf O ROAD—SITE <br /> TRACY CA '(5�7 6 ! TRACY, CA 95776 <br /> Cffero�a Phone: (c f s9 i 8? —1971 ., g-E-EN: 64495 <br /> ;. <br /> 6 Transporter 1 Company Name U.S.EPA ID Number <br /> rTRONSPLIRT, f R T Ks, r <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Faalfty Name and Site Address U.S.EPA ID Number <br /> HERITAGE ENVIRONMENTAL SERVICES LLC <br /> 284 E STOREY RD AZ1:o817o54[}_=' <br /> COOL I DGE, AZ 852-8 <br /> Facility's Phone: ;P r 3— <br /> ga. 9b.U.S.OOT Description(including Proper Stripping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group{if any)) No. T e Quanfity Wt Ncl <br /> 1. I <br /> c4 e, Z-30 <br /> 2. <br /> rx <br /> SI0L`�''_sn_ r. s r r r.amu <br /> { , , , <br /> 3. t" <br /> 0 NON—DOT UNIVERSAL WASTE—MERCURY CONTAINING LAMPS <br /> w u 2-0 f <br /> U_ <br /> 0 <br /> NON—DOT UNIVERSAL WASTE—MERCURY CONTAINING LAMPS <br /> t! 11 QP) <br /> NON—DOT:4^dON—RCRA REGULATED <br /> o- <br /> 13,Special Handiing instructions and Additional Information <br /> 1.W14 Q.275945 2. 1415 053'319 3. WIF, 0,332317 4. W17 05.32378 5. W119 O'C25:355 a <br /> 14. OFFEROR'S CE=RTIFICATION: 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 labeledtplacarded,and are in all respects in proper condition for transport according to applicable lnlegotion5 and national governmej regulations. <br /> Offerces Printedrry d Nanx� Signature Month Day Year <br /> b c' l <br /> 15.Trans Acknowledgment of Receipt of Mate <br /> F- Trans iter rin&D��ped Nam a ure on ay Year <br /> a <br /> a <br /> 0Transporter 2 Prinled/Typed Name ignatu. onth Day ear ,'z <br /> r- <br /> 16.Discrepancy <br /> ' i <br /> 17.Designated Facility Owner or Operator:Certification of receipt of hazardous Bill of Lading/Manifest covered by the manifest except as noted in item 16 <br /> 4 Printed/Typed Name Signature hienth Day Year <br /> d <br /> x _ DESIGNATED FACILII'eTO(-JFF 0R <br />