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<br /> Please print or ty e. ,, Form Approved.OMB No.2050-0039
<br /> UNIFORM HAZARDOUS 1.Generatot ID Number 2.Page 1 of 1 3.Emergency Response'Phone 4.Manifest Tracking Number
<br /> WASTE MANIFEST CAR00018808E 1 (2.00)326-1221 Q0 l,I P. 5 7 6P
<br /> 1
<br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address)
<br /> UNITED PARCEL SERVICE-OAKLAND HUB PLANT ENG UPE FREIGHT / WAYNE GARCIA
<br /> 8400 PARDEE DRIBE 3050 TEAGARDEN ST
<br /> OAKLAND, CA 94621 SAN LEANDRO, CA 94577-5721
<br /> Generators Phone: (877)217-7771 GEN: 118650
<br /> 6.Transporter 1 Company Name U.S.EPA ID Number
<br /> HERITAGE TRANSPORT LLC - TS HAYWARD iND(),-j fl,484114
<br /> 7.Transporter Company NameU.S.EPA ID Number
<br /> II
<br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number,`
<br /> HERITAGE ENVIRONMENTAL SERVICES
<br /> 284 E STOREY RD AZD081705402
<br /> COOLIDGE, AZ 85128-91205
<br /> Facility's Phone: (520)723-4167
<br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes
<br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol.
<br /> 1.
<br /> o NA3077, O-i HER REGULATED SUBSTANCES SOLI D, C. D,1
<br /> N. O. S. 9,PGI I I, (WATER-BASED INF;) ,ERG,171,
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<br /> Z 2.
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<br /> X NA3077 OTHER REGULATED SUBSTANCES SOLIII'
<br /> N.OSS. 9,NI I I, (SURFACTANT, ACRYt_IC t'OLuYME t
<br /> 3.
<br /> NA3082 OTHER REGULATED SUBSTANCES, L IOUID, 1 1)i
<br /> N.0.S, 9y 'GI I I,.(CANOLA OIL_), ERG##171,
<br /> 4. -
<br /> X NA3082 OTHER REGULATED SUBSTANCES LIC�LJID, �. DF Ei.*)
<br /> N. O. S. 9 bGI I I, (ETHYLENE GLYCOL') ,ERG 171,
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<br /> 14.Special Handling 16itructions and Additional Information
<br /> 1.W276 0,14`5418 c.W278 01431002 3.W254 U1392727 4.W277 01430056 (1)920629264 27671664,
<br /> 920629264-1 27671686 (2)274879474 27736759 274879474-1 27737225 274879474-2 27737217,
<br /> 274879474-3 27737168,274879474.4 27737070, 234879474-5 27736889 274879474-6 27736870
<br /> 274879474--7 2773686E (3)274878855 2769454.7 (4)274878866 2 ER� :HERITAGE r117R717361
<br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,ant are classified,packaged,
<br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary
<br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent.
<br /> 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 am a sma quantity generator)is true.
<br /> General r f er s Printedriyped Name \ Signa r Month Day Year
<br /> General
<br /> 16.International Ship a is
<br /> ❑Import to U.S. ❑Export from U.S. Port If e
<br /> ? Transporter signature(for exports only): Date leaving U.S.:
<br /> W 17.TransporterAcknowledgment of Receipt of Materials
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<br /> Transporte drryped Name Signature Month Day Year
<br /> aY S+- I '
<br /> Z Transport 2 Printed yped Name Signatu / Month Day Year
<br /> 18.Discrepancy
<br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection
<br /> Manifest Reference Number:
<br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number
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<br /> U
<br /> LL Facility's Phone:
<br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year
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<br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> UJ 1. 2. 3. 14.
<br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a
<br /> Pdntedrryped Name igh8ture Month Day Year
<br /> J \ ` LE' 1 /9
<br /> EPA Form 8700 (Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR
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