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PLEASE EIMR 1191FESTED WRO 11111111111111 IN III IN 111111111 INN II N <br /> Please print or type.(Forth designed for use on eke(12-pitch)typewritei.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZAFU US 1 Nrr r 2.Page 1 of 3 Emergency Resp—Phone bar <br /> WASTE MANIFEST CAL000018659 2 (800)326-1221�t 43a3746WAS <br /> s. 91 ORP. / DAWN JESS ��4 1w":— <br /> .'33 <br /> BEVERLY ROAD 2180 E. MARIPOSA RD. <br /> HOFFMAN ESTATES IL 60179 STOCKTON CA 95205 <br /> Generator's PKm (209)948-8205 GEN: 11782 <br /> Transporter I company Narhe U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 <br /> 7.Transporter 2 C etrpany Name U S.EPA 10 Number <br /> 8.DenaBed mrrrr��N and 4e U.S.EPA ID Number <br /> HERITAGE ENVIRONMENTAL SERVICES LLC <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> Pacifil es Pte. (520)723-4167 <br /> 98. 9b.U.S.DOT Desalptim(hAArrg Proper S7uppcg Nemo,Hazard Class,C Number 10.Contakrers 11.Total 12.Unit 13.Mhste Codes <br /> HM and Padwig Group(a any)) No. Type Quantity MAW. <br /> 1 <br /> 0 rort+�v*tr..t�- �� e - - <br /> 2. <br /> x RG UN 1950,WASTE AEROSOLS,2. 1, (DO1 f 1 D039), �� ,/,0 331 D001 D075 <br /> ERG#1�6 J --L <br /> D03 <br /> 3 <br /> 7 rOp. <br /> 1 . , <br /> 77 <br /> 4. 1 <br /> 14.Spedal Hand'rg krshacooas and AdMottal kkmiabon <br /> _ <br /> 2.W$ Q450281_LDR BDR _ JG Jc <br /> iv�. rn <br /> III �hI�D / rt-zSaasi1r_I <br /> ( -,ja:�:.wai�::�j.::::rwWb-:.j'vdtiN- - "w u, apuyr&ryMprwrw:du inn uraimimw,pdceagw, <br /> marked and Iebeladloacw4K and are M so re%w*In plover oxxotion for ftmw armrdnn to <br /> Exporter,I Cattily W the Cc+Bwb of 9ta xns:;Z_•' rd tonfwm Oo the�etr,,a of aw:rax+r:!Fl+s Arlt v rinrv,m,.,,r�t rr.a-r <br /> II tlral Yw waeta al on sbtr,.x l idat%d in 40 CFR 292.27(a)(il I am a large quw*pew or(4ni am sma ug*k uo�kbus_ - <br /> .6 - _....r_..__._. :.,.r:.•yex:.:w::v.a. rwawpap:.-.ma. ' <br /> Traroporler stnatta.(fur <br /> Sygiaarre <br /> C 13 3 D <br /> Transporter yped Wnd Sigrilliture Morb Dayear <br /> K <br /> F <br /> 18 D�sap,(vrc/ � <br /> 18a Discrepancy Indication Spate l Oua N ty ❑T,y, L-Residue ❑Partral Rejection FuX Rejechon <br /> Man!rsl Reefer"Nunber <br /> 18b,AJtenrate FacJ4(or Generate) -.. US EPA ID Number <br /> J <br /> U <br /> Q <br /> LL <br /> Fadiry's Phone' <br /> rQ 18c.Signature of Alternate Facility for,r,-e;rcratorl Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes o e.,oades for hazardous waste treatment,disposal,and recong systems) <br /> I`I fJ71rt�2 a 3. 1 <br /> .e.... .,..i.i:.n..... r..!R!..R��lL-.. •� _R.WlAR'!ri.?.M M.eY to -.M:�i •O:. <br /> - <br /> (+ 7 c__— 1' 31 i Y 1/LJ I <br /> - ._ :. - ileSiGrii►TE�i FAGiLr i i w ue�t rpaplt_a� ::. _;:. <br />