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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.3099) See Instructions on bac' ` page 6. Department of Toxic Substances <br /> Please print or type. Form designed for use on elite(12•F ypewriter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No, 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST A 0 10 10 16 11 10 19 14 19 / of 1 <br /> 3. Generator's Name and Mailing Address A.'State Manifest Document Number <br /> INLAND P&P INC (#020—TRACY) 227416. <br /> 0 400 WEST VALPICO ROAD, TRACY, CA 95376 8. State Generator's ID <br /> LO 4. Generator's Phone ( 1 <br /> f\ n <br /> 06 197 1 <br /> N 5. Transporter I Camp cny' ome — 5. US EPA ID Number C. State Transporter's ID[Reserved.) <br /> LO <br /> o HERITAGE TRANSPORT, LLC / SIGNAL I D. Transporters Phone <br /> o I - 1 (562)595-0209 <br /> _ 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporter's ID[Reserved.) <br /> �-� F. Transporter's Phone � <br /> Lo �' w � � z 4 g 8 2 v �� p / sUv- �- cs�` <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> T-4a HERITAGE ENVIRONMENTAL SERVICES, LL <br /> �0 5122 EAST STOREY ROAD H. Facility's Phone <br /> COOLIDGE, AZ 85225 1 1 :p a P R (520)723-4157 <br /> Q12. Containers 13. Total. 14. Unit <br /> U 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) <br /> No. Type Guontity Wt/Vol I. Waste Number <br /> Z a' <br /> State 221 <br /> IION RCRA HAZARDOUS WASTE LIQUID, N.O.S. , 9, <br /> 3 G HA3082', PG III, (USED OIL) ERG# 171 EPA/Other <br /> NONE <br /> C j E 6. <br /> State <br /> o N <br /> aD E / EPA/Other <br /> N <br /> R <br /> 4 A C. State <br /> o T <br /> coo 0 EPA/Other <br /> R <br /> � S <br /> LU d. tate <br /> Z EPA/Other <br /> U <br /> LU <br /> V) J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Z ��� b. <br /> CL A. E.4495-1 <br /> a. L, <br /> Cie C. d. <br /> J _ <br /> _ Q <br /> Z15. Special Handling Instructions and Additional Information <br /> 0 <br /> z 24 HOUR EMERGENCY PHONE #. �,�6 0 <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 national government regulations. <br /> —' If I am a large quantity generator, certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economical <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 /> N and the environment;OR, if 1 am a small quantity generator,I have mode a g d faith effort to minimize my waste generation and select the best waste management method that <br /> available to me and that I can afford. <br /> OPrinte yped Nam Sign re Month Day 1 <br /> U <br /> Z O 06 <br /> w T 17. Transporterill TransporterAcknowled emenl of Recei t of Materials <br /> � R S' a re Month Day 1 <br /> � p Printed/Typed Name � C <br /> N <br /> LU S <br /> " 0 18. Transporter 2 Acknowled ement of Receipt of Materials <br /> LW T Printed/Typed Name Signature f �/J Month a� <br /> LW <br /> h R <br /> U 19. Discrepancy nclicotionpoce <br /> Z F <br /> C Q932 Q�60 <br /> 1 <br /> I 2 Facili Owner or O or Certification of receipt o4 hazardous materia co red 6 This mon est except noted in Item 19. <br /> T Printed/Typed Name lure \ Month Day 1 <br /> Y � , 101f? 101_7L6 <br /> DO NOT WRITE BELOW THIS IIIE. <br />