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05/20/2010 THU 14: 02 FAX 612 696 5163 1&005/010 <br /> lllll�llll�lllilglillll{illlllllllllllll lillllllll(IIIIII�II�II(II�I <br /> Please print or type.(Form designed for use on a its 12-01ch)typewriter.) Form Approved-OMB No,2050,0039 <br /> UNIFORM HAZARDOUS 1.Generator t0 Number 2.Pape 1 of f,Etrergen�y Response Prone 4.Man fest Tracking Number <br /> WASTE MANIFEST CALc?00'63w35 7 — <br /> 5.GenenWs Name and MWir9Addmss Ganeretors Site Address(d different than maifrg address) <br /> TARGET—T0738 REVERSE LOGISTICS SPECIALIST i TARGET—T0738 / EXEC, TEAM LEAD/REV, LOG. <br /> 2800 NAGLEE RD, .?BOO NAGLEE RD. <br /> TRACY, CA 9-0304 TRACY. CA 95304 <br /> Gencralor'sPhone: (209)633'-3494 PEN: 12'961 <br /> b.Transparter 1 Caawny Name U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL JIND058464114 <br /> 1.Trarsponer 2 Ccmhsr.y Nam- U.S.FPA ID Numner r / <br /> r F <br /> >n S <br /> H-Deskonate0 FoCil4y Kame and 51te AWress U.S.EPA ID Number <br /> HERITAGE ENVIRONMENTAL SERVICES LLL <br /> 284 E STOREY RD AZD0A1705402 <br /> COOLIDGE, AZ 85228 <br /> Facib a Phone: (5-c-0)783-4167 <br /> ger 9b.V.S.COT Descnpbon(indudag Proper Shipping DLmre,H:rzafd Class,10 Nuniber. to.Gonreiners11.Total 12 UNI . . <br /> 1„ Waslc Codes <br /> I-Im and Packing Group(If airy')) No. Tyxc Quart" N1 Ivoi. <br /> z � <br /> RQ,UN197B,WASTE PRGPANE,c. 1, (D0b1),ERG#115 U 0f0i...-;31... .......... <br /> 70 <br /> 4 <br /> 14.Spepal Kwaing InsWtlions and Additional Information <br /> -W!R 96129 ItUR—C. 3.WB Q512105_LOR L <br /> l° kS QF <br /> 5�G`� `� �7 L1c79971IC, <br /> 15, GENERATOR'SIQFFEROR'S CERTIFICATION:I hf eby drcJ;Ke Mot the cadent-.at this consignment am hilly and accurately dosrnbed above try the proper shipping name,aTxl are cl.wilted,pai3u]cd, <br /> muked and Iabet drpLscnrdcd,and Nc in atl respects in Proper condition Icr transport ace dmg to applicable inlama6onal and national povemmontal reculatiori If export shipment and I am the Primary <br /> Exparlcr.I ccriily that Inc contents d this cons4v"conform to the arms o1 V,.e allched EPAAcknowledgment of Coneenl. <br /> I artily that the waste minim0fion slatement ipentibctl in 40 CFR 262,27(a)(81 om n large AUM.ty generator)or(b)(ihI am a 97W quantity generator)is true. <br /> 'errerelo 5r�/�ratyped a gna,re ra <br /> OPW ✓l - OT 2- <br /> 1fi.Irnemsaonal Sfupmente , <br /> Impen ro U.S. Export,rom P of en fexA. -- <br /> z Trans iter aranarwe for exports only): Dale Ag U.S.: <br /> w <br /> 17.TransyoTterACMc+f0dgMtofRccaiplofMolae rg <br /> TrarsWcr Prirlcdrryped Name Sig ursMonth URY ear <br /> r)lj <br /> Q CIA4 C1 C <br /> ' s z <br /> 4 Trans lef Typed Name 5gnature month Day Year <br /> — 01a.McTsoancy <br /> 18a.Dlscrapancy Indication Space Ouamity Typo ❑R.aUue ❑Partial Rejection D Full Rejoction <br /> Manihesl Reference Number: <br /> 18D..49enralC FaO14y(or Gt'ne19lof) U,S EPA ID Nomber <br /> J <br /> U <br /> 4 <br /> FaciM Ghone: <br /> 0 18c.Slgnatue ofAupmale Feckly(or G&wobr) Month Day Year <br /> y19.Hazardous Wastr Hepoel Maragernenl l lcut od Coots(i.e..codes tog ba7arr ous waste aeatmenf,disposal,and regdng syslems) <br /> A ?.1. 3. 4. <br /> --H+*t _ H141 <br /> 20.Designated Fatuity Oww or Opeselon Certification of receipt of he7ardoua maNiiala tmerad by the manifM except as noted in Item 168 <br /> 1P;r'AdI typed NJme rc Month Dey Of <br /> Oro D�i <br /> EPA Form 8700-22(Rev.3.05) revious editions are obsolete. D NATED FA TY TO DESTIV <br /> ION STATE SIF REQUIRED) <br />