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05/20/2010 THU 14: 04 FAX 612 696 51.63 0009/010 <br /> 11111111�11111�11111 h111 IIIII IIIII 111111111111 1111111 lillll II 1111 <br /> Ptaasc print or .(Fnrm designad for use on?lite(12-pitM)typewr(ler.) Fonn Approved.OUB No.2050-0039 <br /> UNIFORM HAZARDOUS 1'Cenerato ID Number 2.?age 1 o; 3.Emergency Responsc'hM'3 d.Alanlfast Trackln Number <br /> WASTE MANSFEST EAL000c63335 3 (800).326-1201 00 i i 6 A <br /> 5.`� �°-9`�1 dMYERSE L061STIES SPECIALIST / — .® B�n` �.'9a ?91 LEAD/REV, LOG. <br /> 2800 NpGLE RD. 2800 NRGLEE RD. <br /> TRACY, CR 95304 TRACY, CA 95-204 <br /> (209)833-3494 GEN: 122961 <br /> Generaws Phone: <br /> T.Iransporle(l company Name U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 <br /> 7.Tranaponer 2 Company Name U.S.EPA ID Numbs <br /> i rim a 1'-4A -'r e-j 09 -W, <br /> ask 7!/ <br /> e.��° F� V 1 HUN TAL SERV ICES LLC U.S.LPA-10 Number <br /> 284 E STOREY RD AZD081705402 <br /> CGOLIDGE, AZ 65228 <br /> Hcitxys pfw ne: (520)723-4167 <br /> ga. 9b.U.S.DOT Descnpoon(irxkdinp Propmr Shift g Name,Hazard Class,10.Number, 1 C.Cordamers 11 Tdal 12.Unit 13•W,stC Crxlea <br /> V, and Packing Group(if any)) No. Type Quantity WtNd <br /> a X 1, RQUN1057,WASTE LIGHTERS,-C. 1 (DO01), t 331 D001 <br /> ERG#1'15 6 D 1DR <br /> w <br /> LU x 2• RQ,L041950 WASTE AEROSOLS, FLAMMABLE, D001 331 <br /> N.O.S. ,2. 1, (b001),ERG#126 0 <br /> x a. n�t��ni°?q� I�GTE PROP '--1�an>> rnr_utr 55 <br /> 7' <br /> x 4. mt&`iF� <br /> 14..5oeoal He ftrudnsandAdloonellnforamn <br /> W121 <br /> 12109LDR r <br /> _ 2.617 Q512104 LDR _ <br /> C132725B1G <br /> 15. OENERATOR'S10FFEROR'S CERTIFICATION:I hereby declare That 0R mnlenls of W s mnslamneru are fully and accurately described above by the proper shipping name.and are desaiW packaged. <br /> marked and lebetedlplacarded.and aie in all respects in pmpor corndlor for transport seevndlng w applrable m'ematlmrrsl and national governmental regulations.N amort sNPnlent and em tha Portray <br /> Exporter,I certify That the oontents of this consignment conform to tho lams of the attached EPAAc'movredgmeni of Consernl- <br /> I Certify that Ne waste minimization statement i icn6kd it 40 GFR 202.27(x)(N I am a large quanbly genarelor)Dr(b)Cil am a smell gianbty generator)is true. <br /> n xme gne e c ay Year <br /> 1VI I� oq <br /> -1 16-liftam3tionalShIpments ❑ � --— — --- <br /> Impprl ro ❑ <br /> U.S. Expel h4 U-f Porto(entrytext[ <br /> Tran e' ebrre r exports only): Dalr:leaving U.S.: <br /> w 17.Trangwrtar A0DV le(Wnant of Receipt of Mater ys <br /> 12 Tmn Aniedrryped me Jna re — ay ear <br /> rc LA Et t <br /> aportet2Printad/Typad �re aY Year <br /> a A1 V in <br /> 1B. actepancy <br /> 184.Discrepancy In im Specs ❑ Cl.'y Type <br /> ❑Rasidle Cj peryo Refecllon Full Reieclbn <br /> MaNlesf ReferenKa Number <br /> 18b.Altemalo Facility(or GeneraW U-S.EPA ID Number <br /> J_ <br /> 67 <br /> 6 <br /> �- Fad '&Phorne: <br /> W 18c. )gn*m otAAameoe Fadity(or Generated Morin Day Year <br /> a <br /> z <br /> H19.Hazardous Waste RWA Mansgemerni Mednod Codr (,e,.codes br ha"rd"waste treabnenl,disposal,and recycling systans) <br /> LLI0 1. H141 2 H141 H t q t d. <br /> 20.Designated Feci ty Owner or Operator,Certt cation of receipt of haT9rdom maler"coaxed by the manitst eaoeo as noted In Item 18a <br /> niedfTypedName SgnalVe blonln Day year <br /> EPA Form 8700.22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />