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204244- 1 <br /> HAZ MAT BILL OF 1.Olfaror's ID Number Page 1 of 3.Emergency Reeponse Phone 4 np u <br /> l,ppi#IMANF�BT _ -, •, _ <br /> 5.O[feror s Name and Mailing Address 011arors Ste Address Of different than mailing address) <br /> TIN, INC. (020--TRACY) / DAN PEREZ TIAs, INC (#020—TRACY) l DAN PEREZ <br /> 400 WEST VALPICO ROAD—SITE 400 TEST VALPICO ROAD—SITE <br /> TRACY, CA 95376 TRACY CA 95376 <br /> offerors Phone: (209)836-1971 GEN., 4495 <br /> 8.Transporter 1 Company Name U.S.EPA ID Number <br /> I <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> HERITAGE ENVIRONMENTAL SERVICES LLC <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> Facilitft Phone: :?_ <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Norm,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit <br /> HM and Packing Group(I1 any)) No. Type Quantity Wt.Nol. <br /> 1. <br /> I <br /> , <br /> (u 4 z3 V <br /> 2. <br /> x <br /> cc <br /> 3. <br /> NON—DOT UNIVERSAL WASTE--MERCURY CONTAINING LAMPS <br /> Y. a. <br /> I NON—DOT UNIVERSAL WASTE—MERCURY CONTAINING LAMPS <br /> tLIDP <br /> NON—DOT/NtON—RCRA REGULATED <br /> >�Pf <br /> 6. <br /> 7. . <br /> 13.Special Handling Instructions and Additional Informatlon <br /> 1.W 14_(2275945 2.W 15 0532319 3.W16 (2532317 4-W17 0532378 5.W19 0259558 - <br /> PT <br /> 2955 .PT <br /> P'r 4y <br /> 5.4 <br /> 14. OFFEf WS CERTIFICATION: I hereby declare drat the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iebeled1placarded,and are in all respects in proper condition for transport according to applicable irk and national govemmenty regulations. <br /> Offerors Printed)71 NSignature Month Day Year <br /> 15.Tran Aclurowtedgment of Receipt of <br /> Tmns&wPdntyAfTyped Nam re month Day Year <br /> Transporter 2 PrintekVTyped Name Signature month Uay Year <br /> 18.Discrepancy <br /> 17.Designated Faality Owner or Operator:Certification of receipt of hazardous Bill:of Lading/Manifest covered by the manifest except as noted in Rom 16 <br /> Prinled[Typed Name Signature Month Day Year <br /> a <br /> VIM DIESIGNATED FACILITYTO OFFEROR <br />