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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-991 See Instructions on bac" ' page 6. Department of Toxic Substance <br /> Please print or type.. Form designed for use on elite 11 2-j ypewriter. Sacramento,Colifornic <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal low, <br /> C Al 0E, 10 '' 49 of _ <br /> 3. Generator's Name and Mailing Address A. Slate Manifest Document Number <br /> I NLAIID P&P INC (#02'.O-TRACY) 2 2 014 7 J <br /> 0 4,',0 WEST VALPICO ROAD, TRACY, CA _�C:'?i_. B. State Generator's ID <br /> W) <br /> A. Generator's Phone ( ) <br /> if <br /> sC rs - rte? <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> HERITAGE TRANSPORT LLC / '31GUAL HI L. <br /> Y D: Transporter's Phone <br /> 0 I H I) 0 _ 4 4 1 114 (56 )"59`-02 ? <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.) <br /> jAff 9JA 4 Q S F. Transporter's Phone. <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> �a HERITAGE ENVIRONMENTAL 'SERVICE_:, LL <br /> ®0 <br /> 512'12 EAST STOREY ROAD N. Facility='s Phone <br /> C 0 COOLIDGE, AZ IO 6 A Z U 0 C, <br /> 1111710151410 '� (520)7' -4167 <br /> IN <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Classand ID Number) 12• Containers 13. Total 14. Unit <br /> 0d U No., T e Quantity Wt/Vol I. Waste Number <br /> 11011 RCRA HAZARDOUS; WASTE LIQUID, 11.0.'S. 1 'S, State '`ii <br /> �- HA308 , PG III, (USED OIL) ERG# 171 <br /> G O EPA/Other <br /> 11011-1 <br /> cE r s State L <br /> N NA RCRA HAZARDOUS WA=,TE :_OLID (OILY ABSORBENTS*) :_ 1 <br /> T E <br /> v R 1 EPA/Other <br /> q A t State <br /> o T NdN RCRA HAZARDOU' WASTE SOLID N.O.'S. , 9, NA:SQ77, 1 <br /> 0 0 PG III , (OIL FILTERS) ERG# 17� r 1� EPA/Other <br /> oe <br /> R ! a� NON <br /> w _ _ State <br /> Z - �W - <br /> TE <br /> U► `^ EPA/Other NON <br /> v' <br /> 'LU <br /> rn J. Additional Descriptions for Materials Listed Above -K. Handling Codes For Wastes Listed Above <br /> Z <br /> O A. 64495-1 O ( b. <br /> w B. 64495-2 <br /> C. 64435--3 C. s� d. <br /> Q ' <br /> Z 15..Special Handling Instructions and Additional Information <br /> a -`4 HOUR EMERGENCY PHONE #: <br /> Z <br /> LU <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nationol government regulations. <br /> J If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicall, <br /> a practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heal)) <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that i <br /> °C available to me and that 1 can afford. <br /> 0 <br /> >. Prig/Typed 7me � �//� Signgtur� Month Day Ye <br /> U 1 / <br /> Z1-1 <br /> 6 TR 17. Tra orter 1 Ac ow dement of Recei of Materials <br /> W <br /> APri ted/ yped No S' r Month Doy Ye <br /> LW R ` l �i O <br /> LW s <br /> W a 8. Tran or r 2 owle em nt of Recei t of Materials <br /> 0 R Printed/ N A1611 <br /> tur sjAon t D ,�Ye <br /> T <br /> w E <br /> 'n R <br /> Q <br /> () 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 120, Foci ity Owner or eroto Certification of receipt of hazardous materia co Bred by this konifest e e t as noted in Item 19. <br /> T nted/Typed Name no ure t Month Day Ye <br /> 10 10 <br /> DO NOT WRITE BELOW T IS LINE. <br />