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"fie.._ .. :".)� s�'."'c}3 .���✓�� _ ,...t''Y ,. 1IHI�I���I���t����������■.1�I��1����I�'��1��.11 I�I���II��� <br /> Please print or type. Farm desWed bor tae on eft 12 Formrt <br /> .OMB No.220500039 <br /> 1 :c"WYAtAR t 1 8659 Rgncc 1 4 =438 i WAS <br /> 3333 BEVERLY ROAD 2180 E. MARIPOSA RD. <br /> HOFFMAN ESTATES IL 60179 STOCKTON CA 95205 <br /> (209)948-8205 GEN: 11782 <br /> Generators Rum: <br /> Tw <br /> H I AG RANSPORT, LLC / SIGNAL HILL u.s. NDM484114 <br /> 7.twmwW 2 Carrpeny Name US.EPA b Narmber <br /> NTAL SERVICES LLC US EPA IDWmtw <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> (520)723-4167 <br /> F e Ph": <br /> fm. %U.S.DOT D (ndu3ng proles ShOOV Name,/lazartl Clap.IC Number, 10.Confairwa <br /> HM and P dare Gray(t any)) 11.total 12.UM 13.Waste Codes <br /> No, Type Quantity WINd. <br /> X 1. RQ UN10571WASTE LIGHTERS,2. 1, (D001), 331 D001 <br /> ERG#115 p <br /> \Df-)L% 1 I <br /> X 2 ' t 331 D001 D035 <br /> ERG#ic6 <br /> C y a P D039 <br /> X 3 Ro,UN1978,WASTE PROPANE,2. 1, (DO0P,ERG#115 331 D001 <br /> Tkcy')(Ap) I cy a P <br /> X 4. UN3159, 1, 1, 1,2—TETRAFLUOROE HANE,2.2, 331 <br /> ER #126 <br /> 3r' x3P �y 3 <br /> 144f?I&15mwjr_ 450281_L R 3.W140439584_LDR 4.W240,520854 <br /> �X3o x55 1115 (qo) l �3 <br /> Kai 11332150713 <br /> 15. (3ENMMR'SIOFFEROR'S CERTTFICATION:I herby dedm Uw tM oatare d ft tonsOwnat ore h1y and amaaly desaibad atm w by#*poper OWpN nnar ne,and aro desy ed,packaged, <br /> makad am taoaiedfplecarded.and aro in as respects in proper aondnon b hn$Pnrt acoadng b appkatis nlennworw end neuxw powmnenly regitaUona.I(amw a Wwad and I am the Pdma y <br /> EXPabr,l car*arel the oonnamh Of this oaagnrnwt cmbm to Sue Jenne of Ov altscred EPA Adaorbdgmmt d Caroat <br /> I oa ttfy that ft mms rrirtmaaw atelenwt Wentlod in 40 GFR 28227(s)(X I am a targe wwAwy gwwymp or(b)(KI am p aril gerwalor)illureCienerew . <br /> V W P7jz-Lv AAV(pj <br /> l ear <br /> 1 16.Inteasuonal 1 0 <br /> Import to U. ❑Expori Yom U S. ) Pat <br /> T fore Dale U S.: <br /> W 17,TmePaler Admoate r*M of RwW of MawWs <br /> Transporter 1 Pfintedayped Name <br /> r Ym <br /> 10 <br /> ?� Transports 2 PMt.&Typd Name month <br /> Day Yew <br /> 16.SOW" <br /> 16a.Daff"W y trndlcawn Space ❑ o'.y ❑Type ❑Residue ❑partw Rejecdon ❑FW R*clon <br /> Merrilea ReWa ce Number <br /> 18b.Aheman Fadaty(a Genera" U S.EPA ID Number <br /> U <br /> t <br /> W F8,tys Phone: <br /> 15c.Signature of Ahwnaee Fadity(or Gawator) <br /> < Month Day Year <br /> 2 <br /> 1g.Hazard"Waste Report Manegenmd Metmm Codes(I.e.,codes for hazardous waste naerwmt disposal,and mLydN systems) <br /> 1" H141 2. H141 3. H141 ° H141 <br /> 20.Designsled FKWy orrw or Operabr Ceftkakn of Moo of hazardous meWials covered by the men feel except as rdW in Ilam 18& <br /> Swakure - Month Day Yew <br /> - / 9 �tJ <br /> EPA Form 970022(Rev.3-05) previous editlons are obsolete DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />