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<br />Please print or type. Form Approved. OMB No. 2050-0039
<br />EPA Form 8700-�2 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR
<br />UNIFORM HAZARDOUS
<br />1. Generatot ID Number
<br />2. Page 1 of
<br />3. Emergency Response Phone
<br />4. Manifest Tracking Number
<br />WASTE MANIFEST.-,
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<br />(800) 32,6-121,..
<br />i-)000_ �" 3k- 1`�rtf`�.`.^,
<br />5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address)
<br />UNITED PARCEL. SERVICE --OAKLAND HUB i PLANT ENG UPZ FREli�HT I WAYNE GARCIA
<br />84001 PARDEE DRIBS 3050 TEAGARDEN ST '
<br />fJAY,LAND, CA 94621 SAN LEANDRO, CA 94577-5721
<br />Generators Phone: (977)217-7771 GEN : 118650
<br />6. Transporter 1 Company Name U.S. EPA ID Number
<br />lIERITAGE TRANSPORT LLC - TS HAYWARD INP.058484114
<br />7. Transporter 2 Company Name U.S. EPA ID Number
<br />:.,^ LLc�r ��5 72-1 j
<br />8. Designated Facility Name and Site Address U.S. EPA ID Number` "
<br />HERITAGE ENVIRONMENTAL SERVICES
<br />284 E STOREY RD AZD08170540c
<br />COOLIDGE, AZ 85188-9205
<br />Facility's Phone: (52 f) 723-4167
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<br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
<br />10. Containers
<br />11. Total
<br />12. Unit
<br />13. Waste Codes
<br />No.
<br />Type
<br />HM
<br />and Packing Group (if any))
<br />Quantity
<br />Wt.Nol.
<br />o
<br />1.
<br />NA3077 OTHER REGULATED SUBSTANCES SOLID,
<br />N.O. S. 9, �GII I, (WATER -EASED INK), ERG4.171,
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<br />2.
<br />NA3077 OTHER REGULATED SUBSTANCES SOLID
<br />bGI t'OL,YME,LR.
<br />Z'FlRr
<br />N. 0. S. 9, I I, (SURFACTANT, ACRYLIC
<br />5 +�
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<br />3.
<br />NA3082 OTHER REGULATED SUBSTANCES, LIQUID,
<br />bGI
<br />1
<br />J.:_(::/
<br />N. O.S. 9� I I, (CANOLA OIL), ERG#171,
<br />4. -
<br />NA3f)82 OTHER REGULATED SUDS GANGES LItaUID,
<br />bG
<br />1
<br />DF
<br />60(:,
<br />N. 0. S. 9; I I I, (E1-HYLENE GLYCOL) , ERC�k 1.71,
<br />14. Special Handling In Wctions and Additional Information
<br />1. W276 Q i 425418 2.W270 01431002 3.W254 01392727 4.W277 01430056 (1)9='01529264 2715711564,
<br />920629264-1 27671686 (2)274879474 27736759 274879474-1 27737225 274879474-2 227737217,
<br />274879474-3 2773-1168,2274879/474-4 .'2773707o,21,4879-474-5 277 36889 2%79474-6 27736870
<br />274879474--7 27736866 (3) 274878855 276n,94547 (4) 274878866 '' ER1 : HER I TAGS 111792,7171 f:i?
<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, and 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 EPA Acknowledgment 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 smal quantity generator) is true.
<br />General r 1 er s Printed/Typed Name t. Signa r .---- -- Month Day Year
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<br />16. International Shipme is
<br />❑ Import to U.S. ❑ Export from U.S. Port if entcyll
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<br />Transporter signature (for exports only): Date leaving U.S.:
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<br />17. Transporter Acknowledgment of Receipt of Materials
<br />a
<br />Transporte;j,&i�ed/Typed Name Signature^^ --:.� Month Day Year
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<br />-Tr7n7po-rf 2 Printed/Typed Name Signatu Month Day Year
<br />18. Discrepancy
<br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection
<br />Manifest Reference Number:
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<br />18b. Altemate Facility (or Generator) U.S. EPA ID Number
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<br />Facility's Phone:
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<br />18c. Signature of Alternate Facility (or Generator)
<br />Month Day Year
<br />ZZ
<br />55
<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />0
<br />1.
<br />2,
<br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a
<br />Printed/Typed Name Signature Month Day Year.
<br />EPA Form 8700-�2 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR
<br />
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