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i Illlll lull INTI 1��i�ll IliIIVIII lull lull till lllllil llllll Il Illi Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 4-j-0263335 �, (8f�t3)32G-1^c21 00027 68WAQW 5. gp tIl!st�ame,�[)djd�ikngA�drS VERSE LOGISTICS SPECIALIST / G r ri S�teAt�df}s�S t�rffe t r� Ii:ga e414 LEAD/REV. LOG. 2800 NAGLEE RD. 2800 NAGLEE RD. TRACY, CA 95304 TRACY CA 95304 Generators Phone: (209")833-3494 GEN: IE2961 6.Transporter 1 Company Name U.S.EPA ID Number HERITAGE TRANSPORT, LLC / SIGNAL HILL IND038484114 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number HERITAGE ENVIRONMENTAL SERVICES LLC 2$4 E STOREY RD AZD0�81705402 COOLIDGE, AZ 85228 Facility's Phone: (52))723-4157 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.Nol. o X 1 RG,i)N1057,'WASTE LIGHTERS,2. 1, (D0()1), _. 31_. Diri�i_ __-- 0 ERG#115 �s ! IJ j W Z 2. ) UJI X RQ,UN195U WASTE AEROSOLS FLAMMABLE V 0 I33.1_.'____ _.... t N.O.S: ,2. 1, l),ER6#126 60 T X 3 c r r r = X 4. tJN-646,1 lEiniHM, i '9_a l=, 21 � / ..-.....L Z1..,.L.�....-...._ I 14.Special Handling Instructions and Additional Information C 2.0 � C i rr❑ rlCi iii- 6BR _ir f"fCi_iiri 1.W12 G!,,121U9_LDR .L)7 O�ic:i u4 SDR _r - ixs" fix - - - [134174370 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 labeled/placarded,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 EPAAcknowledgment 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 amp*7Wkquantily generator)is true. Gene r tor's/Offerors Pnnted7Typed Name ! ature n ar ay e hS J 04 tot II� J 16.International Shipments j... ❑Import to U.S. Ll Export from U.S. Port ofntry/exi Transporter signature for exports only): Dale le vin U .: 17.Transporter Acknowledgment of Receipt of Materials t2 Trans er 1 P'nted/Typed Name Signal _ Month ay Year a I 111 /51/6 QTransporter 2 Printed7Typed Name Signature Month Day Year tY f- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Altemale Facility(or Generator) U.S.EPA ID Number J U a Facility's Phone: ,UU 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. H141 H141 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name gna Month Day Year L) �� ►� EPA Form 8700-22(Rev.3-0 ) Previous editions are obsolete. �DEVGNATED FACILITY TO DESTINATIO TATE(IF REQUIRED)