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lIIIIIIIIIIlII!!!IIlIII!!IlII!!llllllllllllllllllllllll !!I!I!I!lIII! <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone Martifest <br /> WASTE MANHOT . C;AT000610949 2 (800).326-1221 7712WAS <br /> s. �aNr edMq MTRACY) f DAN PEREZ Ger)er� 'silrl iess� ► ) DAN PEREZ <br /> 400 WEST VALPICO ROAD—SITE 400 WEST VALPIC:O ROAD—SITE <br /> TRACY, CA 95375 TRACY CA 95376 <br /> (209)836-1971 SEN; 4495 <br /> Gormereto�s Phone: <br /> Transporter Company Nam U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 <br /> 7.Transporter 2 Coptpany Name U.S.EPA ID Number <br /> �R�ONMNTAL SERVICES LLC U.S.EPA ID Number <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> Fadill rs Phone: (520)723-4167 ;w' <br /> ga. 9b.U.S.DOT Description(inducting Proper Shipping Nam,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Wade Codes <br /> KM and Packing Group(d any)) NO. Type Quantity WtNd. <br /> X 1' RQ,UN1950 WASTE AEROSOLS FLAMMABLE, D00 513 <br /> N.0.S. ,2. 1, (FAINT), (D001),EhG#126 <br /> u, X 2. RQ NA3077 HAZARDOUS WASTE SOLID, N. ,5. , D00 <br /> 9,PGIII, (MERLURY), (D009),ERG4171 ' P <br /> 3' <br /> NON RCRA HAZARDOUS WASTE SOLID (OILY 22 <br /> ABSORBENTS) Z DMJ 60 <br /> , r�i"1 ISD w _..- <br /> ��J <br /> 4, NON RCRA HAZARDOUS WASTE SOLID (OIL � Z5_ <br /> 22 <br /> FILTERS) Q <br /> 41. NBdg��s a itio2I I �€��8 9LDR 3.W2 0532 299 4.W3�� <br /> l 1"� f <br /> 1139050416T <br /> 15. GENERATOR'SIOFFEROR'3 CERTIFICATION: I hereby declare that the contents of this oonsfgnment are fully and accurately described above by the proper shipping name,and aro dessified,packaged. <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable Internadaaland national governments[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 EPAAclwawredgment of Con M. <br /> I certify that the waste mhmim®tion statemeM identified in 40 CFR 282.27(a)(If I am a large quantity generator)or(b) ell generator)is true. <br /> Gen~sloftrors ere m <br /> L-n ` (J <br /> 18.Intenrationel IF <br /> ❑hay to U.S. ❑Export from U Pat of entry*dt <br /> Tran for exports only); Dateleavi U.S.: <br /> 17.Trans of Receipt of rials <br /> Tire I NamMonthgn <br /> ca !V �D <br /> Transporter PrintedFlWed Nalhe gn re ear <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejed, <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Fadi s Phone: <br /> 18c.Signature of Afiemate Facility(or Generator) Month Day Year <br /> LU <br /> rg 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 1 H141 Z H141 3. H141 4. H141 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pr$ntedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNArED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />