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I IlIIII��11111�11 Illil III ��lll illll II��I 11�1111 �����lII II��I II SII <br /> Please print or type.(Form designed for use on elite 12 Itch)typewriter.) Form Approved.OMB No.20RMS <br /> UNIFORM HAZARDOUS 1.Generator lD Number 2,Page 1 of 3.Emergency Response Phone .Man1" 77 A <br /> WASTE MAb�EST . CAT000610949 (800)326-1221 T l �M <br /> 6. <br /> . ItisPRACY) / DAN PEREZ Ge'1° ' ; las — reje) DAN PEREZ <br /> 400 WEST VALPICO ROAD—SITE 4Or3 WEST VALPICO ROAD—SITE <br /> TRACY, CA 95376 TRACY CA 95376 <br /> (209)836-1971 GEN: 4495 <br /> Generators Phone: <br /> 6.Transporter pan! U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC i SIGNAL HILL IND058484114 <br /> 7,TTransporlK 21 y Name U.S.EPA ID Number <br /> 1. tiE �1�ta1 NTAL SERVICES LLC U.S.EPA ID Number <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> Facill Phone; <br /> (520)723-4167 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Nur, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Paddng Group(if any)) mbeNo. Type Quantity MAW. <br /> X 1. RQ,UN1950WASTE AEROSOLS FLAMMABLE, DOO 513 _ <br /> N.0 S. ,2. 1; NINT), (DO01),EhGO126 2� <br /> W X z' RQ NA3077 HAZARDOUS WASTE SOLID, N. .S, , (/ DOO <br /> 9,PGII I, (MER�URY), (I)OO9),ERG4171 1 <br /> 3' NON RCRA HAZARDOUS WASTE SOLID (OILY 22 <br /> ABSORBENTS) t5D <br /> � jJ <br /> 4. NON RCRA HAZARDOUS WASTE SOLID (OIL <br /> FILTERS) CID& vc--ILI I F'r 1 z5— P L± <br /> 14 ;I 1 1 258 9 LDR 3.142 U532299 4.W3053230 <br /> C 139051347 GT <br /> 15. GENERATORWOFFEROR'S CERTIFICATION: I hereby declare that the cunkft of this consignment are fully and accurately described above by the proper shipping name,and ere classiW,packaged, <br /> marked and laheledlplacaMed,and are in all respects in proper condition for transport a000rding to applicable Intamatbrtal and national govemmentot regulations.If export shipment and I am the Primary <br /> E)gawter,I cartifyr that the contents of thla consignment conform to the temps of the attadted EPA Acknowledgment of Co n4 <br /> I cw*that the waste minimization afatement lden#W in 40 CFR 282.27(a)(It I am a large quantity generator)or(b) all generator)is true. <br /> oars are ea//r�� <br /> LnLe-44.lc17 <br /> Ll <br /> hternaldnei <br /> [:]Import to U.S. ❑Export ham U Port of entrylexib <br /> Tran nature for exports onl : Date leati U.S.: <br /> 17.T meat of Receipt of Is <br /> 9 ear <br /> ZooA & <br /> Transpoder2 fttaCyped Nafhe Signawre 01 mom L)SY 'rear <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantify ❑Type ❑Residue <br /> Pardal Refection El Full Rejection <br /> Manifest Reforance Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> Fad' s Phone: <br /> 18C.Signature ofAltemata Facility(or Generatorj Month Day Year <br /> r� 18.Hazardous Waste Report Management Mettwd Codes(Le,,codes for hazardous waste treatment,disposal,and recyding systems) <br /> 1. r H141 2 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 Nem 18a <br /> F rintacifTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED i"ACIL(FY TO DESTINATION STATE(IF REQUIRED) <br />