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All <br />Please Drin <br />I or tvoe. (Form desioned for use on alta 112iNiorti v6 �ta,.i' <br />1101111111111111111111111111111111111111111111111111111111 <br />Form ADDroved. OMB No. 2060-W39 <br />EPA Form 8700-22 (Rev. 3 05) Plevious editions are obsolete. <br />DESIGRATED FACILITY TO DESTINATnTATE (IF REQUIRED). <br />UNIFORM HAZARDOUS 11-Vu%�253 <br />2. Peg <br />1. EmTL%�, C <br />""-!TT21 <br />4. Mariffes rac <br />tT M <br />)MUN4388WAS <br />WASTE MANIFEST <br />5. et1288 7 EP M <br />LP <br />MANAG7=7- <br />5110 PACIFIC AVE 5110 PACIFIC AVE <br />STOCKTON, CA 95207 STOCKTON 95207 <br />;CA <br />(209)475-6500 GEN: 119223 <br />Generators Phone: <br />6. Tpr1 Cc' Vme <br />HERITAGE RANSPORT, LLC 1 SIGNAL HILL <br />U.S. EPA ID Number <br />IND058484114 <br />7. Transporter 2 Company NameT <br />U.S. EPA ID Number <br />" r -. <br />Z <br />8. NAL SERVICES LLC <br />U.S. EPA ID Number <br />284 E STOREY RD <br />AZD081705402 <br />COOLIDGE, AZ 85228 <br />(520)723-4167 <br />e <br />Fadis Phone: <br />08. <br />9b. U.S. DOT Description ('holuding Proper Shipping Name, Hazard Class, ID Number, <br />10. Contain ers1l <br />Total <br />12. Unit <br />13 Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (If any)) <br />Quantity <br />Wt.Nol. <br />q: <br />X <br />RG UN19501WASTE AEROSOLS, 2.1,(DO01 D035), <br />ERG#1�6 <br />331 <br />D001 D035 <br />f 2006- e . L) 9 10 <br />im <br />Uj <br />X <br />RQ,UN19713,WPSTE PROP`ANE,2.1,(D00'A),ERG#115 <br />331 <br />D001 <br />a <br />I �� I . .9 -f <br />I <br />X <br />3. UN3159,1, 2.2, <br />f <br />331 <br />ERG 12.6 <br />/;Z,) <br />X <br />'- RG LW1993 WASTE FLAMMABLE LIQUIDS, N.O.S., <br />3'PGI1,(PAIW,(D001),ERG#128 <br />214 <br />D001 <br />C-� <br />00-c-� C41 Z <br />I <br />I <br />1i.'%Y%V5%'/rrttVddllkeWM58793 `LDR 3.'W17 0527176 4.W9 0458790 LDR <br />[133215736 <br />I& GENEMTORIKIFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and actunately described above by the proper shipping name, and are classified, packaged, <br />marked and labeleftlacarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment <br />and I am the Primary <br />Exporter, t cer* that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br />I oMkWj_*W_a9b minimization statement identified in 40 CFR 262.27(a) (it I am a large qua 2!!3'11��am a sm entity generator) is true. <br />'4 <br />03 <br />-j <br />16.1 El Import to U.S. 0 Expert from U.S. Port of entry/exit- <br />signatum (for Pft L -W: Date leavi2a U.S.: <br />17. TransporterAdnowledgment of Receipt of Materials <br />0 <br />Tra Nam tree <br />! ay ear <br />IL <br />r— /I <br />Transporter 2 Pd Name I signature <br />ay YEW <br />cc <br />10) <br />Discrepancy <br />I18. <br />18a. Discrepancy Indication Space ❑ Quantity El Type El Residue <br />El Partial Rejection <br />0 Full Rejection <br />Mantled: Reference Number. <br />18b. Alternate Facility (or Generator) <br />U.S. EPA ID Number <br />LL- <br />Fail'tys Phone: <br />18c. signaturs of Alternate Facility (or Generator) <br />Month Day Year <br />Z <br />19- Hazardous Waste Report Management Method Codes (.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />LAJ <br />0 <br />1 H141 <br />2 . <br />I H141 <br />3. <br />I <br />4. <br />H141 <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted In ftern 18a <br />PrintedlTyped Name <br />^ Month Day Year <br />EPA Form 8700-22 (Rev. 3 05) Plevious editions are obsolete. <br />DESIGRATED FACILITY TO DESTINATnTATE (IF REQUIRED). <br />