Laserfiche WebLink
r ::: . ,'- �=.;-r` .: i 1�1i!MI INTI VIII�Ih IiIN INS VIII INII IiII NINA ih�11 lel <br /> Please print or type. <br /> ..(Forth for use Oft 10b 12-p*typewriter.) Form Approved.OMB No.2050-0039 <br /> IJ MI HAZARDOUS 1,Ganeralw b Number 2.Pegs 1 of 3.Emergency Response Phare 4.Yandw T=pggWq <br /> WASTE wAwFEST CALOOOO 18659 2 (Soo)-226 1221 <br /> INSORP. / DAWN JESS <br /> B V RLY 0 D 2180 E. MARIPOSA�RD. <br /> HOFFMAN ESTATES IL 60179 STOCKTON CA 952015 <br /> GeneraGYa Plane: <br /> (209)448-8205 GEN: 1178: <br /> U S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC-COOLIDGE IND058484114 <br /> 7. mnsporlar 2 Name U.S.EPA ID Number <br /> tM <br /> I gT NEy RR0NM NTAL SERVICES LLC U.S.EPA ID Number <br /> 'IRAJDGEORAZ 85228 AZDI817it54�:c <br /> Phone: <br /> (520)723-4167 <br /> ga. 9b.U.S.DOT Desaylbn(Including Proper Shipptrg Nome.Herard creep D Number. 18.Cardeinwa 11.Told 12.Urt 13 Waste Codes <br /> HM and packing C-W(t any)) No Type Ouentity W11-1w. <br /> 1. <br /> X RD UN1950,WASTE AEROSOLS,2. 1, (D001 D039), �F 331 D001 D035 <br /> ERG#126 <br /> roc r 9 3 r' Dong <br /> X 2. RQ,UN1978,WASTE PROPANE,22. 1, (D001),ERG#115 C /U 3.31 D001 <br /> 3. <br /> 484— <br /> 1 <br /> X 4 RRQ IN199' WASTE FLAMMABLE LIQUIDS, N.0.S. , 11 !� D001 Y <br /> 3,PGIt, (RA 4t), (D001),ERG#128 l <br /> 14. t strtict orte and AddiBonal Inbnretion <br /> 1. 8 O t_�81 LDR 2.W 4 0439584 '_DR �^ u.Wi-` 345+:,03 LDF <br /> w Fl-". r <br /> l k112425o. 7G <br /> 15. GENERATOR'9/OFFEROR'3 CERTIFICATION I hereby declare that the W**of this wnslgnrn nW are fi*arid accurately described above by the proper shipping name,and ane dassdled,Packaged, <br /> marked and labeledplerarded,and are in no teepects in proper conmon to transport acwrding 10 appacade w0erraEorul and national govemewtal regulations.If export shipment and I am the Primary <br /> Exporlw,I cw*that the contents of It a condgnment conform to the lame of the attached EPAAdmawiedgntent d Comae. <br /> I certify the was%rrwrkni ation statement identified'n 40 CFR 26227(a)(I I am a large quantity,garwatlr)or( amA small qw"Y tor)is the. <br /> s ear <br /> i <br /> 16.Imenewo Shillaments 'EIII to U.S. ❑Export Iom U.S. Part Of entry®cit <br /> T to Data leaviro U.S <br /> 17.Twmporbr Acknowledgment d Receipt of Matxeta <br /> reypsd ay ear <br /> f4 to 1 <br /> r <br /> Trarupor9ar yped ams y e <br /> 16.Discrepancy <br /> 18a.Discrepancy WWIcation Space ❑ 0--y ❑Type ❑Residue ❑Partial Reiec aon ❑Fuil Rejection <br /> Mardkest Reference Number <br /> 18b.A1lemae Facility(or Generator) US EPA ID Number <br /> V <br /> r+- F s Pha1e: <br /> d� i . ' true dAttemate Facility(o C-enlikw) Month Day Year <br /> 2 <br /> 19.Haardous Waste Racier Management method Codes ti e.,codes for tezada,s vrasb treatiment disposal,and recycling systems) <br /> UJ <br /> 1. H141 2. H141 3. 4 H141 <br /> 20.Designated Faaity Owner ot Opera{or Centihraflon d mtceipr d hazard"materials covered try the manifest except as noted n hem i as <br /> yped NameS Month Day ear <br /> as 10q <br /> EPA Form 871X1.22(Ren.3-05) Previous editions are 0111 <br /> e. DEWRNATETFAC&M TO DES 00N STATE(IF REQUIRED) <br />