COMPLIANCE INFO_2010 - Laserfiche WebLink

Home Browse Search

ilIIIII Illi!IIIII 1��lli IlIII IIIII Ilili IIIII Iili iilllll 111111 li(III Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator 10 Number 2.Page 1 of 1 3.Emergency Response Phone Taniffest Tracking Number WASTE MANIFEST CALL O02'E,;335 j 0 t f 32 —12- •f 5.Generators Name and MaiI Address Generator's Site Address(if different than mailing address) TARGET—T0738 REVERSE LOGISTICS SPECIALIST ! TARGET—T0738 / EXEC. TEAM LEAD/REV. LOG. 2800 NAGLEE RD, '2800 NAGL EE RD. TRACY, CA 953204 TRACY CA 95304 Generator's Phone: ('20 t9)8332-324 94 PEN: 32'2'2:961 6.7ransporterl Company Name U.S.EPA ID Number HERITAGE TRANSPORT, LLC / SIGNAL HILL JIND058484114 7.Transporter 2 Company Name U.S.EPA ID Number n s cv� 8.Designated Facility Name and Site Address IU.S.EPA ID Number HERITAGE ENVIRONMENTAL SERVICES LLC 284 E STOREY RD AZDO81705402 COOLIDGE, AZ 85228 Facility's Phone: 520)723-4167 4167 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10 Containers 11.Total 12 Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Vol. 1. W Z 2. 3. RQ,UN1978,WASTE PROPANE,2. 1, (D001) ,ER13#1 15 v 001. ..331 ._ 4. 14 Special Handling Instructions and Additional Information =.WB_051c105 LGR to i.,_5.5 t _ C 1'2799711 G 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified.packaged, marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator'(Offerors Pri (Typed N e rgna ure Month Day Year 16 International Shipments F— ❑Import to U.S. Export from .,S P of en iexit. Transporter signature for exports only): Date n U.S.: 17.Transporter Acknowledgment of Receipt of Materials Trans iter PrintedrTyped Name x gnalure ont ay ear U C c , r CL aTranspo me Typed Name ignature onth Day Year .1 — 0 18.Discrepancy ` 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q LL Facilit's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z V, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1 2. -4#*l - H141 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pr,1edrTyped Name re Month Day Year 1 OCO t>�6 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. �DW TED FA I`TY TO DESTITT ION STATE(IF REQUIRED) -- --o"