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05/20./2010 THu 14: 04 FAX 612 696 5163 0010/010 <br /> . I <br /> I IIlil!IIID 111111lDIDll�ll!!!IIlII IIIA Illll IIIIlIII�I IIIIII ll fill <br /> Please prini or type.(Form designed for use on elite 02-pgch)typawriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Goneraw(ID Numbor 2.Page 1 of 3.Emergcnq Response Phone l Man eatTrackln Number <br /> WASTE MANIFEST CAL000263335 3 (600)3126—1221 447�772WA5 <br /> S.Cenersbes Name and Pddrees Garemmes Sdo Add asa(if(M erenl t1w md%V edoress) <br /> TAMET—T0738 / REVERSE LOGISTICS SPECIALIST / TARGET—T0739 / EXEC. TEAM LEADIREV. LOG. <br /> 2800 NPGLEE RD. 2800 NAGLEE RD. <br /> TRACY, CA 95,304 TRACYCA 95304 <br /> Generator's Phare: (209)833-3494 GEN: 122961 <br /> b.Transposlar I Corrmy flim U.S.EPA 10 Number <br /> HERITAGE TRANSPORT LLC /:SIGNAL HILL IND058484114 <br /> 7.Transporter 2 Compar a U.S EPA ID Number <br /> 6.oeslgnaw MILEY Name dnd Slle Address U.S.EPA 10 Number <br /> FIERITP.GE ENVIRAi�MEI�lTAL -SERVICES LLC <br /> 284 E,STOREY':.RD,n AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> FaelltyS Phbne' .. (520)723-4167'. . <br /> 9a. 9b.U.S.DOT Desmpdon Qndudlg Ropy Shipping Naris,Haan d Ck=.t0 Number. 10.Coma oars 11,Total 12.Olt 13,vers a Cod-S <br /> HM and Padit Gmup(d any)) Np type t3uanny WE mi. <br /> 1. <br /> A <br /> i E <br /> uA <br /> .X.. 2. RQy W1,95Q UPS6E .AERf3S 9 I-LZMABLE, <br /> N.0.S,,2. i,.(b.aoi);l=l G#126 �3 <br /> 3. <br /> x R0,UNiS78,WASTE PROPANE,2. 1, (D00 ),ERG#115 <br /> a. <br /> i <br /> 14.Special Kard4 lnaudons and Additional ln, nWon <br /> ',W12,104 LDR, 3.k8 0512105—L DR 4�13���t <br /> ch� <br /> C 13173211 G <br /> 15. GENERATORVOFFEROR'S CER11MATtft:lhaieby.derjam that the carats of vs consor mwi am fully and wcuemely descitnW above by he proper s*pery r4une,and are dla Ommi,psaaged, <br /> nrerked and Iaheledrpbplde0,3M are fn""elGceapecfa in potter caditron,ar transport according b appl�de iNrannlional and nedanal gooemmernal regulations.II a�pM SPipmenl end I am the Pritnary <br /> Exporter.I wrtiFj.tttat'd+a rpmerda d dda edneigriolerll'con(omi to gietams dthe arched EPApcla>oWtodgn+enl U Consent. <br /> I car*Bmt did waste ml0m1mion elammatt identiFo In 40 CFR 26227(e)(d 1 am a IarF WandN gorwaler)or(b)(HI am a awl quantitygarreralor)is tnA, <br /> of aPrnladT)"d Now monm aYda< <br /> Lv 113 L t�� 1SApt <br /> i 16.intewdonef Shpments <br /> ❑Import to U.S. ❑Erport from U.S. Pon of enoyl exu _ <br /> t Tra somEwry for eyoft anm! MAW leavng U.S.: — <br /> �' 17.Tn SWW Adlrld vW#nwtd Receipt Of htetedefe <br /> lid <br /> ay ear <br /> � � Nana naorre /V �� I <br /> CC <br /> Z Trartsporter2P NarnaGr ur0 n DaY <br /> yew <br /> Q d 7 1 d <br /> 18L Wawa" <br /> 18a.Diarfapwcy Ir O mt1w Space ❑ ❑Tyro ❑RegJdue ❑PA,*Hefecton ❑Ful Radia <br /> Marded Reference Number. <br /> 15.—.e F—*Ry(or Generator) U.S.EPA 10 N~ i <br /> J <br /> 0 <br /> LL FadWs Phare: Month Day Year <br /> W ,ec.Sigrature of Alternate Fad1Ay(a Garwala) <br /> r— <br /> 19.Haaardow Waste ROW Management Medved Codes(Le-,codes fa ha�7ldous vtasle treabr�eat deposal,and necytlYg systems) <br /> 0 1' [IL' <br /> 13- 4. <br /> —� H 141 H 141 irk <br /> 20.Dealgmted Faddy 0%WW or Operator.Cerd cation of reo*l of hazudous matndals coveW by IDB M lfj 91 wmw as now m bm lea <br /> Prirrtedrry➢ed SirJtalure hbem Day Year <br /> L U o9 <br /> EPA Form 87(10 T2 Premousedil"m are obsolete. nKIGNATETell <br /> TY TO DESTINATION STATE(IF REQUIRED) <br /> I <br /> I <br />