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IIID!VIII VIII VIII IIIlI ILII VIII 1111111 Pill 11111111111 <br /> Please print or type.(Form designed for use on elite(12- itch)ty er.) Form <br /> Approved.OMB No.21350-C <br /> UNIFORM WARDOUS 1•Genarefor ID Number 2.Page i of 3.Emergency Response Phone 4.Manifest Tragi 07713WAS <br /> WASTE MANIFEST CAT000610949 1 (800)326-1221 <br /> Nr .Ma R� RACY) i DAN PEREZ Gorr Sit, .5j d"# DAN PEREZ <br /> 404 WEST VALPICO ROAD—SITE 4170 WEST VALPICO ROAD—SITE <br /> TRACY, CA 95376 TRACY CA 95376 <br /> (209)836--1971 GEN: 4495 <br /> GBneCatDr'B Phone: <br /> 6.Transporter I Compaq Name U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA iD Number <br /> 11 n�6 U.S.EPA ID Number <br /> 2004 N. AL MEDA STREET CATOBOO13 352 <br /> COMPTON, CA 90222 <br /> Fadkft Phone: (310)537-7100 <br /> go, 9b.U.S.DOT Description(Including Pmper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(If arry)) No. Type Quantity MIM. <br /> 1. NON RCRA HAZARDOUS WASTE LIQUID (USED OIL) 22 <br /> 7 1 M - - <br /> � 21• <br /> 0 <br /> 3.� <br /> 4. <br /> 14.Specfai�I�xaions and AddKonal Infonnalicn <br /> E7�F��b�5k� ' <br /> [1,39050633 <br /> 15. (IFNERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedere that the contents of this consignment are fully and som ateiy described above by the proper shipping name,and are classified,packaged, <br /> marked and labeiedtplacarded,and are in au respects In proper condition for transport according to applicable intemetionaland national governmental ragtjistions.If export shipment and I am the Primary <br /> Exporter,I carlify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Con <br /> oKffy that the waste minimization statement Identified In 40 CFR 26227(a)(if I am a targe quantity generator)or )(RAA BAOR quan eneretor)Is hue. <br /> s amsz9griaturel montil Day, Year <br /> 6 z �� <br /> 16.Interkitional Shipments <br /> ❑import to U.S. ❑Export fmm Port of orrbylexit: <br /> T nature for exports only): Date leaving U.5•: <br /> 17.T Aad-,%dgrnent of Receipt Vilterfais <br /> P � nor re Year <br /> { 6 <br /> f�: 18b- <br /> sporter 2 Pdntew typed Name nor re ear <br /> ndication Space ❑ Quantity ❑� ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Facility Manifest Reference Number. <br /> ity(or Generator) U.S.EPA ID Number <br /> LL V <br /> 1ttc.Signature ofAttemate Facility(or Generator) Month Day Year <br /> nE20D..jg,n.fed,F.Fa,ci1ity <br /> HaiadWaste Report Management Method Codes(i.e•,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2.Owner or Operator:Certification oCreceipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> e Signature Month Day Year <br /> EPA Form 3700-22(Rev.3.05) Previous edit is are obsolete. DESIGNATED<ArNLIT P-)DESTINAfIOgid r•.��r((F Rt_-Q 0f-'._1 <br />