Laserfiche WebLink
e prr1t or type.(Form designed for use on elite(12-pitt#1)lypevniter.) Form Approved.OMB No,2050-1039 <br /> UNIFORM K42ARDOUS 1.Gererawr ID Nunber 2.Pape 1 of 3.Emergency Response Pnone 4.WOW TneWng NUMW f <br /> WASTE MANIFEST CAD0006330 1 (800)321-31542 000269601 WAS <br /> 2�WES�HNGTONTS RE.ET LLC I MICHAEL (�I TERSR 2700 WEST WASHINGTON STREET t MICHAEL PETE <br /> STOCKTON, CA 95203 STOCKTON CA 95203 <br /> (205)466-4407 GEN: 120104 SURVEY; 97432 <br /> 3enetatn?s Phone: <br /> 5,Transporter 1 COMRDY Name U.S.EPA m Number <br /> HERITAGE TRANSPORT, LLC—COOLIDGE IND058464114 <br /> I.Trw4poffu 2 OomWy Name U.S.EPA 1D Number <br /> B. <br /> Wed <br /> TAG Name <br /> NV I RONMENTAL SERVICES LLC U-S.EPA III Number <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> Fat9lbs Phone: (520)723-4167 <br /> ga. Bb.U.S.DOT Dagor0ion(mctudog Proper Shipping Name,Hazard CJdss,Ib Number, 10.Container 11.Total 12.Unit 13 Waste <br /> HM arra Padang Grob m any)) No. T)"; Quantity WtNol. <br /> X t. R0,UN1325 WASTE FLAMMABLE SOLIDS ORGANTC, 4 DSI 2280 P D001 DO18 511 <br /> D00is;ER&#1337;(4550M) SOIL). (bolt� 2)W7 S <br /> 2 NON RCRA HAZARDOUS WASTE SOLID (GRAVEL), 2 DM 1290 P bii ! <br /> (2x55gDM) <br /> 3. } <br /> 4, <br /> ILVal liendlinq nstnl ice and Additional Informal on <br /> 1.W 1 i� C�d518177 2.149018045 (1)17, 18, 1'9120 (C)211222 <br /> t 1 JC347113 6 <br /> 15. GEW-VTOR'S10FFEROR'S CERTISCATION: I hefty d"re ittdt lite contends of this cormsignnrerd are fully and accurately deacribed above by the proper shipping name,and are d=606,packaged, <br /> marked and labele0acardea,arra ars in all rttpacts in proper condition for trarmport according to sppkable Intern a Dnal and national governmanml reputations.If export shipment and I am the Primary <br /> ExpQnV4T.I wtHy that the co*,nts of Ws comlonment oWomn to the terms of the sttaclred EPA AdmowWgmerd of Conaent <br /> I tetany tat ft waste mininvAon statement 6Tfied m 40 CFR 26227(a)(d 1 am a large quandry generator or(b)(If l am a smail quandcy generator)Is true. <br /> n aro e n me rs y ear <br /> 16.ntarnaticnal Shipmanis El <br /> Import m U.S. ❑F.xDort fram U,S. 4ng <br /> Tran ature fore its org U.S- <br /> 17.Trarmporl&A00owWymCd of Receipt of Maiaals <br /> Transporter 1 Pftdedqyw Name gnawre Mony Year <br /> v.ti QQ <br /> Transporter 2 PrinWayped Narne SignatiW, MDnth Day Y138T <br /> 18.Discrepancy <br /> 18a.Discrepancy Indlcadon Space ❑ QuaraY TM ❑Residue ❑Partial Re)ection ❑Full RO&C ton <br /> KarNt Reverence Number. <br /> 18b.Alarata Facility(or Generator) U.S.EPA ID Number <br /> Fed' s Phone: <br /> i8c.Stgrature d Attamata FaciIJ4(or Generator) A"h DaY ser <br /> 12.Hezerdous waste Report Marlagemem Method Coda(Le,modes for hazardous waste bw;lrr� disyosal,and reGON system) <br /> 1. i, 3. 4. <br /> H141 H141 <br /> 20.Designated F"ty Owner or Operator:Cerlfficatien of receipt of hwwdom materials or mvd by the mar>lfest except as noted In Item 18a <br /> do Name Signature DaY ear <br /> Form 8700.22(Rev.3-05) Previous editions are obsDlete. DESIGNATED FACILITY TO DESTINA714k STATE(IF REQUIRE) <br />