Laserfiche WebLink
Pupasa iow�ss IIIIi{I1�1{IIIIII'Illnlll{� Illllllllllalll111lilllfliln !In <br /> Please print or type.(Form designed for use one*(12 jMch)typewriter.) Form Approved,()MB No 2 <br /> Generator 10 Number Page 1 d 3 Eme gency R Phone 1.Yanrfeet Track) Number <10 <br /> UNIFORM HAZARDOUS CAL000018659 2 ( ncy )�-1221 (� <br /> WASTE MANIFEST V44��l VM^lAy °y <br /> 5 GS�t�' RP. / DAWN JESS G9!4A9ftp el�'�! '4gC'l C'gC�E'i2F <br /> 3333 BEVERLY ROAD 2180 E. MARIPOSA RD. <br /> HOFFMAN ESTATES IL 60179 STOCKTON CA 95205 <br /> (209)48-8205 GEN: 11782 <br /> Generato(a Ptare ; <br /> Transporter I Company Name U.S.EPA ID Number { <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND05884�84114 <br /> 7 Trans / 1 ter 2 Company Name <br /> ��� r 'd U19-eb /P599,Z± <br /> 6 2 I HVCN f 1 ftU1Vf. NTAL SERVICES LLC U.S.EPA 10 Number <br /> 284 E STOREY RD AZDoS170540-0 <br /> COOLIDGE, AZ 85228 <br /> (520)723-4167 <br /> Facia s Phone (520)723-4167 <br /> 9b.U.S.DDT Description(imiudng Proper Shipping Name.Hazard Gass,ID Number. 10.Containers 11 TOW 12.Unit <br /> HM am PA"Grow(d any)) No. Type Cvanbty miVal. 13 Waste Codes <br /> ,x X 1 RQ UN1950,WASTE AE SOLS,2. 1, (D001 D039), 331 D091 D035 <br /> O ERG#116 \ r q <br /> e )2 q ) CF I D039 <br /> ZX <br /> LUX <br /> / ,` , X X 331 D001 <br /> 7 <br /> X ° RQ IJN1993 WASTE FLAMMABLE LIQUIDS N.0.S D001 <br /> 3,PGII, (PAINf), (D001),ERG#128 p <br /> Cox 76 <br /> t�S f I q cionsLa tiq�al�3 -0R 3. 4.W12_0450303 LDR <br /> 11286649313 <br /> CC IGFx <br /> 15. GENERATOR'SIOFF CERTIFICATION: I hereby dedare Vial the contents of this consignment am tuey and acc+aately desmbed above bytfieproper shipping name,and are dassified,peckaped, <br /> marked and labeledrplacarded.and are in aH respects m proper condition for transport according to applcaDle rn1wralanal and national governmental regulabone.N export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Ackrnwledgrt»rd of Coram). <br /> I certify that the waste minimization statement identi9ed in 40 CFR 262.27(a)(if I am a large quantity gerteretorl or(b)(HI am a quantity enerator)is true. <br /> rin � turer <br /> -j 16. intarratfs Sh pments <br /> 0 lrnpori to U'S Export horn U P d entr*dt <br /> = Transporter signature for exports on Date leaving U S. <br /> 11.Transporter AcknoMedgmerd of Receipt o//!Materials <br /> ra er 1 P M me SKInak" Month Day G CJlfL lir D ear <br /> 2 <br /> Z T e 2 Printedayped Narn Signature orth Day <br /> --n fL-,F� <br /> ,6 <br /> 18a Discrepancy Indication So Q,;anbry _ Tvpe l__�l Resdue LJ Partial Relectiwl Fuil Refection <br /> Manliest Reference Number <br /> IBb Attemele Facfly rur Generator) U.S EPA ID Number <br /> J <br /> V <br /> a <br /> LL Facile 's Phone <br /> W 18c.Signature of Alternate"racflify(or 6enoralor) Month Day Year <br /> for <br /> Z <br /> H <br /> 19.Hazardous Waste Repnn Marnagemenl Mettlod Codes(,a woes for hazardous waste treatml,disposal,and recycing systems) <br /> 1 <br /> H141 2 —4444— --r,: — ' H1 41 <br /> 20.Dmgrated Faalily Owner or Operates.Certification d receipt or hazarrtous materials covnred by the mandast except as nded in Hem!Be <br /> rinfedflyped Name Month Day Year <br /> 10-1 1 10 loci <br /> ON STATE(IP REQUIRED) <br /> EPA Forth 87M22(Rev 3 5) Previous editions are obsolete. 1U�TOCKTINAD N <br />