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05/20/2010 THU 14: 03 FAX 612 696 5163 zoos/010 <br /> Please print or type.(Form designed for use on ellia(12-ollch)lypewriler,) l ll!!il llll!11111llll�lll 11111�111lllli llll lei N�ll�illl!��1051-0039 <br /> UNIFORM HAZARDOUS 1.Genoralor ID Number 2.Page 1 of 3.Emwgancy Resmnse Phone 1 Manifest Tracking Numbcr 000 <br /> WASTE MANIFEST '')L 0Q263132 � 3 (900)`0-6-1221 00027 <br /> 5. HKb)Ytl T `I gAddrEatVERSE LOGISTICS SPECIALIST / �A` ` J� a7nt E :° 1 LEAD/REV. LO& <br /> 2800 NAGLEE RD. 2800 NAQLEE RD. <br /> TRACY, CA 95304 TRACY CA 95304 <br /> (2109)6,7,3-3494 GEN: 122q-0'1Generator's Prone: <br /> I ranspwer 1 Comparly Name U.5.tPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484i14 <br /> 7.Transpaner 2 Company Name U.S.EPA ID Number <br /> B.D"parted Faciq Name and SPe Address U.S.EPA 10 Number <br /> HERITAGE ENVIRONMENTAL SERYICES LLC <br /> 264 E STOREY RD RZD081705402 <br /> COOLIDGE, AZ 85'-)8 <br /> Facility's Phone: (520)726-416t <br /> ca. 9tx U.S.DOT oesomidn(Aeuding Prcper Shipping Name:Hazard Chas,ID Number. 10.Coma nors 11.Teta) 12 UNI 13.Waste Codes <br /> HM and Packing Group Cif any)) No Tape Quantity WV4. <br /> Of t. <br /> X ERG#Q115N1057,!�R5TE LIGHTERS,21. 1, (D001)!s IJ <br /> D <br /> z 2. <br /> UJI X RQ,UN1950 WASTE AEROSOLS, FLAMMABLE, ROD <br /> N.0. <br /> S.,21. 1, (fool),rRG#126 <br /> la I <br /> 3 <br /> X - <br /> d. I <br /> NORtF850,2. 21 <br /> 14.Spectal Handling Inshudon6 Sfvj Addilosl Inrarmaaon <br /> .1.W12_Q512109 LDR 2.147 Q512104_LDR _ _ _. + <br /> )C <br /> [13417431 13 <br /> 15. GEtjfPATOR1S10FFEROR'S CERTIFICATION, 1 hereby declare u,at Ne contents of this consignment are linty and a=aMy deXfbed above by Ale proper shipping name,and are classirixd,padaged, <br /> marked and 13beledfpiacaraK and we h all respects In proper condllon for Iranspon according to applicaNe ir.smational and rational gNerrvmnial regulatlerns.n export shipmenl and I am the Primary <br /> Ezpoll✓:r,I certyy that the consents of his cons.gnment conform 1.6 Ire terms of the attached EPAAcknoWedgment Df Consort. <br /> I ccrliy M the Wada mlydmlr gon alinement.denAOed in CFR 262.27(s)(if 1 em a large quenGry,generator)or(b)(f I am rs gvlrtity generator)Is Lrue. <br /> em e n yp ame re y ear <br /> vi 6 J L< a1n I I p <br /> Tm <br /> cj 16,Inrernailonal Shipments <br /> ❑Import to U.S. Export from U.S. Porto( nlry/oxi <br /> ? Tran er° nature for exports ons OaLe le <br /> W <br /> 17.Tramrpylt,,Aumow,edgmentofRecelptofMateriels <br /> r" rano t P nlodlTyped NamMonth Day Year <br /> V3 Arr <br /> S alone on ay Y"Y <br /> Tra�poder2Pewe"ped ams 9n <br /> 1B.Discrepancy <br /> 1&t Discrepwwy 1ndradan Space ❑ quantity ❑Typp ❑Residue ❑Portia)Rejection ❑Fall Rejection <br /> Manifest Reference Number. <br /> 1 bp.Aaemate Facility(or Generator) U.S.EPA 10 Number <br /> V <br /> Q <br /> W FaeAl's Phone: <br /> w I k.Sir�hnturC Of Atlernale F rCl AY(rx Generemn) Mon h Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Managamend MdhW Codes p.e.,codes for hazardous waste healmenl,disposal,and mgdmg Ypti ms) <br /> 3. 4 <br /> 1 <br /> H141 2 H141 444 <br /> fn <br /> osignaladFaxality Owner or Operator.Certification of rewipl of hazardous matedafs Covered by the manifest except as noted in Ilem IdaledlTyped I _ n Month Day Vear <br /> ,7-.- <br /> EPA Form 8700-22(Rev.3-0 Provlals edIdons are obsolete. �DETED FACILITY TO"!ATE(If REQUIRED) <br />