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05/20/2010 THU 14: 03 FAX 612 696 5163 0006/010 <br /> 111111110111111111111111111111111111111111111111111111111111111111111 <br /> Please print of type.(Form designed.or use on elft(12-pitch)Pypewliler.) Form Approved-OMg No.2C;5'-Dp3g <br /> UNIFORM HAZARDOUS 1 Ser>Fx:11or ID Number 2 Page 1 of 7. n eiynKY kas se Kne 1.Mar0i hacking Number <br /> WASTE MANIFEST I CAL000263335 3 (aU())326-1221 <br /> R VERSE LOGISTICS SPECIALIST / N + R °tWelni LEAD/REV. LOG. <br /> TRAEY, G4 95304 TRACY CA 95304 <br /> (209)833-3494 GEN: 122961 <br /> ocncro;ors'honc <br /> 6. mnsporer'Com5any Namo U.S.EPA IDNumbef <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 <br /> 7.Transportw 2 Cornadrry Namt; U.S.EPA 10 Number <br /> a ' tl"PF#9r ( TAL <br /> SERVICES LLC J.S.EPA 10 Nienber <br /> 284 E STOREY RLQ AZ0081705402 <br /> CQflLIDGE, AZ 85228 <br /> (520)723-4167 <br /> Faci4ly'5 Phone: <br /> 93gh U s DOT DescrlpGon(includnxi Pr(ryrvn Slrppmg r4ame,Hazard Class,10 Nuu10er. 10.Containers 11.Total 12.Unit Q.Wmto Codes <br /> HM amd Pwking C�raup(many)) vo. Type Quantity Wt.N01 <br /> o X ' RQ UN105-7,WASTE LIGHTERS,2. 1, (D001), p 3.7,1 001 <br /> ERG#1115 1 3 <br /> b Fx <br /> X z. RQ,UN19S0 WASTE AEROSOLS, FLA ABLE, I 0001 331 <br /> rot0.S.. ,2. 1, (0001),ERG#126 <br /> i <br /> K 3 <br /> �JdeioPff:'Vff8M12104_LDR <br /> S I x Zo �1+ J V+ <br /> ti28893&]G <br /> 15. Gi*RATOR'&OFFEROR'S CERTIFICATION: I hereby declare that the contents of Ilia corslgMreN are filly and accurately destibed Above by the proper shipping narno,and are Classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for tianspod o cormN to applicable mtemational and national egovemmen'et regulaticni If exood shipmdm af10 1 nm me Primary <br /> Exposer,I certify that the contents of this consignment conform to the terms of the ailadred EPA Aciiinmedgmam of Consent. <br /> I certity real the waste MAMiZabOn 510110 m identned in 40 CFR 262.27(a)(f I am a large Fwlay genera:cr)w(b)(if I am a small gW Lily generator)Is We. <br /> Genera ,e s * me be r sy ear <br /> �j 16.Intemauorlal Shlpi <br /> r IE Import to U.S. Egnrt hom U.S. Pon of envylext -- <br /> 2 <br /> Tramer s'rawre Jbir onli Date iivivinq U.S.: <br /> 17.Transw*r ArknD0*menl 0 Raceipl of Maks-Is <br /> Transporter 1 Prinkvt/iyped am _ anature ay Err <br /> 14 <br /> a <br /> CA 0W-1 <br /> Monthay P.Af <br /> QTrary;tprlei 2 f'rintedlTyped Name <br /> r <br /> 1a.Discrepancy f- <br /> 1l1a DLhcrepanry Indlcmlion Spic El CANinety El T,,,, Res dfk Parodi RT".n Full Rejeclion <br /> Mamfcsl Reference Nwlber. <br /> 1180.Allemate Fmlily(a Gene:+lur) U.S FPA IC Number <br /> J <br /> U <br /> Q <br /> VnrilrNs Prions: <br /> 19c Signawfe of Ailemale Facility for Gen.rrlor) Monter Day Year <br /> a <br /> z <br /> y19.Hozardacc Waste Repon Management MOMW Codcs Ir c„cods tm hazardous waste(eatnrent-Jrt pUsel.and recycling systems) <br /> 1 <br /> H141 z H141 <br /> 20.Designated Facility 0.mcr or Operator.Cenifcauon of re W ipl or Munrdws,mle/als covered by the manikSl except as noted in Item 1 Ba <br /> Pr[AMWTyped Name Signature Month Day yeAr <br /> 40+tet/i-z —y- -e— I cot� <br /> EPA Farm e7W22(Rev,3.05) Previous editions are obsoleie. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />