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I IIIlIIIIIIIII!!!I{I{I IIIII III!!HIlIII{II111111111118{1!!IllNilllll Please print or type.(Form designed for use on elite(12-pitch)typewdter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS I.Generator ID Numho 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trac N WASTE MANIFEST . ONO f0949 (800).326--1221 ' � 77 i awA s.GT9"mNTNVMaI!It5`t"WFRACY) / DAN PEREZ Get""$ �ess ' � th ge4dre�s) DAN PEREZ 400 WEST VALPICO ROAD—SITE 400 WEST VALPICO ROAD—SITE TRACY, CA 95376 TRACY CA 95376 (209)836-1971 GEN: 4495 Generator's Phone: .Transporter I Company Name U.S.EPA 10 Number HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 7.Transporter 2 Company Name U.S.EPA ID Number e.D pnaledfacltitvl4arpa.and Site9ddres�NTAL SERVICES LLC U.S.EPA ID Number 88411EFlLSTTOtRNEYY1KRUDNf AZD081705402 COOLIDGE, AZ 85228 Facility's Phone: (520)723-4167 ga. 9b.U.S.DOT Description(including Fri Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(B any)) No, Type Quantity WI.Nol. cc 'f, 1. RO,UN1950 WASTE AEROSOLS FLAMMABLE, 1)001 513 R N. O.S. ,2. 1, (PAINT), (D001) ,E�tG#126out 2S -- t-- —•. _ I X 2' RQ NA3077 HAZARDOUS WASTE SOLID, N. . S. , !/ Dooli 9,PGI�II, (MERCURY), (D009),ERG4171 ^ -- 3' NON RCRA HAZARDOUS WASTE SOLID (OILY /J ^ 22 ABSORBENTS) / D A�1 l5D (P 1 I_/ 4. NON RCRA HAZARDOUS WASTE SOLID (OIL { 22 FILTERS) — 14.Sp Hajjp.p Ijs�mytl_ons and A07al IM aeon } s '2299 4.W3 1x532 0t i. U.cc J 'c'.W' 1 Qc58 9 LDR 3.W2 05., 113905043GT 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and ere dassilled,packaged, madred and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and 1 am the Primary Exporter,I certify that the contents of this consignment conform to the toms of the attached EPA Acknowledgment of Con nt. I certify that the waste minim¢abon statement identified In 40 CFR 282.27(a)(It I am a large quantity generator)or(b) all qua generator)Is hue. nereto s Nam igna ure n 7 ay Year 6/ ✓Z L -1 18.International Shipments F ❑Import to U.S. ❑Expel him Port ofenhylexit: z Tons ersi naturefor ex orts onl : Date leavin U.S.: Ix w 17.Trans knowledgment of Recelpt of tercels F minsporter 1 Pd ped Name �gna n ay Year !0 a Trenspodo2PdntedlTyped Nae ignafure o y ear K f I 18.Discrepancy 18a.Discrepancy Indication Space Do..fi ❑Residue ty El ❑Partial ReJectlon ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL FacilitYs Phone: aa 18c.Signature of Alternate Facility(or Generator) Month Day Year 2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and mcyding systems) 1. ' H141 2. H141 3. H141 4. H141 1 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdnted7fyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILI TY TO DESTINATION STATE(IF REQUIRED)