Laserfiche WebLink
Please print or type.(Form designed for use on elite(12-pitch)ty)ewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOIJ$ 1.Generstar ID Number 2.Page 1 of 3.Emergency Response Phone 4 Alan t Tka <br /> WASTE MANIFEST. CAT000 10949 2 (80x3).326-1221 =77 12WAS <br /> ` 5. N d MTRACY) / DAN PEF Gs�} �' �'' M� red) DAN PEREZ <br /> 440 JEST VALPICO ROAD—SITE 400 NEST VALPICO ROAD—SITE <br /> wo TRACY, CA 95376 TRACY CA 9537£ <br /> (209)836-1971 GEN. 4495 <br /> Cerrerator's Phone: <br /> Transporter pang Name U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 <br /> 7.Transporter 2 CoRmny Name I U.S.EPA ID Number <br /> "nWNWTO 1 f t tNTAL SERV ICES LLC U.S.EPA ID Number <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> F s Phone: <br /> (520)723-4167 I <br /> ga. gb.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> HM and Paddng Group(if any)) No. Type Quantity Wt.Nd. <br /> X 1 RQIUN1950 WASTE AEROSOLS FLAMMABLE, D00 513 <br /> N.Q.S. ,2. 1; ( HINT), {DOl�1),EtG126 LF 2�5_ <br /> X 2. RQ NA3077 HAZARDOUS WASTE SOLID, N.M. ; ` I)00 <br /> 9,PGIII, (MERLURY), (D409),ERG4171 ' 7 le <br /> 3' NON RCRA HAZARDOUS WASTE SOLID (OILY � 22 <br /> t 1>041 /SDABSORBENTS) / / <br /> 4. NON RCRA HAZARDOUS WASTE SOLID (OIL 22 <br /> FILTERS) CID 1Q <br /> 1asp@cayt V9"Ir T 2S8 9 LDR 3.112 0532299 4.W3 (2532, <br /> 0 <br /> W7X '� /,Dr-, s <br /> C139450436T <br /> 15. GENERATO %%*'M01VS CERTIFICAT*N: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping mama,and are classified.packaged, <br /> marked and labandfplacarded,and are in of respects in proper candltion for transport aocording to applicable internationaland national mentof regulations.If export shipment and I am the Primary <br /> F_xporW,I ow*that the conterds of this coneonment conform to the terms of the attached EPAAckrwwledgrnent of t <br /> I certlgr that the waste minimization statement identl1l d In 40 CFR 282.27(a)(if I am a large quenttly generator)or(b) ti qua generator)is true. <br /> Name re ear <br /> L---, 17—S116 <br /> � 16.Irtemavoirel 5h ❑Import to U.S. ❑Export tram U Part of erttrylsxlC <br /> T nature for on1 : Date leavingU.S.: <br /> 17.T menl of Recdpt of els <br /> No na Year <br /> N !V b <br /> Transporter A. <br /> 2 PrintadlTyped Nae re y ear <br /> 1&,Discrepancy <br /> 189.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Referenoe umber: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Fad' s Phone: <br /> LaR <br /> 1 ttc.Signature of Alternate 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. ' H141 2' H141 3. 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 /> PrinMTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />