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Please print or type.(Farm des* Wert for use on elite(12-pitch)typewriter.) Form Apprcwed.OMB No.2060.0039 <br /> UNIFORM HAZARDOUS 1'Gerrerata IU Number 2,Page 1 of 3.Emergency Response Phone 4.Mantfest Trade <br /> WASTE MANIFEST . CAT000614949 � (800).326-1221 7Lll <br /> 5. s �r*d i �fRACY) / DAN PEI EZ erfT shim ess rerDAN PERE2 <br /> 4t)0'WEST VALPICO ROAD—SITE 4VALPICO ROAD—SITE <br /> TRACY, CA 95376 TRACY CA 95376 <br /> Generator's Phone: (209)836-1971 GEN: 4495 <br /> Company ane U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 <br /> 7.Transporter x Cgnpany Name U.S.EPA ID Number <br /> aj! MMM <br /> NTAL SERVICES LLC U.S.EFA ID Number <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> FadWo Phone: (520)723-4167 <br /> ge 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(If any)) No. Type Quantity WWI 13.Wade Codes <br /> ce X 1. RQ,UN1954 WASTE AEROSOLS FLAMMABLE, 000 513 <br /> e N.0.S. 12. 1; (SAINT), (DO01),ENG# r <br /> 22 <br /> . L/ r <br /> X x. RG NA3077 HAZARDOUS WASTE SOLID, N. .5. , D0a <br /> 9,PGI�II, (MERCURY), (DO09),ERG4171 Q �— --- <br /> 3' NON RCRA HAZARDOUS WASTE: SOLID (OILY r 22 <br /> ABSORBENTS) / on l5D _. <br /> 1 I'1 <br /> 4. NON RCRA HAZARDOUS WASTE SOLID (OIL � 22 <br /> sp�FILTERS) <br /> 1a1 7HIMIns}�nCID LS-J.1 <br /> ®LIJR 2 258 9 LDR 3.W2 t�53 299 4.W3 053C X10 <br /> l DFT , y [ D )6� l,DlAk ry <br /> f:#.3945047 GT <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION; I hereby declare that the contents of Ibis consignment are fully and accurately described above by the proper shipping name,and ere classified,packaged, <br /> marked and Iabeled1placarded,and are In all respects in proper condkion for transport according to appficabte international and national gov®mmental regulations,tf export shipment and I am the Primary <br /> Exporter,I Cartify that the contends of thls cans*gnment canfarm to the terms of the attached EPAAdmawledgment of <br /> I cerbly,that the waste minimization statement identified In 40 CFR 262.27(a)(If I am a large quantity generator)or(b)Cc t all qua generator)Is true. <br /> Genera s ame Signature monp. Day yea <br /> tt� Z <br /> 16.Intematki nal Showtr <br /> or <br /> 11 Impb U.S. ❑Export tram U Pod of enkylexlt <br /> Tra Lure for onl Date leavl U.S.: <br /> V.Tra nt of Receipt of Is <br /> ame Sig month usy Yew <br /> /g <br /> Transporter 2 Pdnt&Tyyped N a1he wature Month Day year <br /> 18.Discrepancy <br /> 18s.Discrepancy Indication Space ❑ Quan' <br /> My ❑Type ❑Residue ❑Partial ReJecwn 1-1 F.11 Rejecliat <br /> Manillost Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> FOCIs Phone: <br /> 1kSigrehrre of Afiemate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(*.a.,Codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 H141 2 H141 3 H141 a H141 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item f8a <br /> Printedfryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. OESIGNArED iFACILIrf TO DESTINATION STATE(IF REQUIRED) <br />