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State of California—Environmental Protection Agency <br /> Form Approved OM6 No.2050-0039(Expires 9.30.99) See Instructions on bac' page 6. Department of Toxic Substances <br /> Please print or type. Form designed for use on elite(12-pi pewriter. 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 C� A T 0101 C) E 1 0 '� 4 `�. 1 � s of 1 <br /> 3. Generator's Name and Mailing Address A. Stole Manifest Document Number 2274191 <br /> 2 7 4 1 9 <br /> INLAND P&P INC. (020—TRACY) L <br /> o PO PDX 10215, TRACY, CA 95376 B. State Generator's ID <br /> Ln <br /> to A. Generator's Phone 1 ?0,;) -:�F_ 9 <br /> f\ - <br /> CV 5. Transporter 1 Company Nome 6. US EPA ID Number C. State Transporter's ID(Reserved.] <br /> W') HERITAGE TRANSPORT, LLC / SIGNAL HI <br /> p I H D [1 8018,141 1 1 D. Transporter's Phone (562')595-0209 <br /> O <br /> a� 7. Transporter 2 Company Name B. US EPA ID Number E. Stole Transporter's ID(Reserved.] <br /> Q / IND ?l IQ�f (�O F. Transporter's Phone I 6—z OO- g-� Y675— <br /> M U 9. Designated Facility Name and 5 to Address 10. US EPA ID Number C G. State Facility's ID V <br /> r-IQ HERITAGE ENVIRONMENTAL °=ERVICES, LL <br /> Z5122 EAST STOREY ROAD H. Facililj's Phone <br /> 0 COOLIDGE, AZ 852"'^ A Z D i1 .- 1 7 0 5 4 0 (52 1>72�-41E7 <br /> 12. Containers 13. Total 14. Unit <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> U No. I Tye Quantity Wt/Vol I, Waste Number <br /> Z NON RCRA HAZARDOUS WASTE LIQUID, N.O.S. , 9, state 221 <br /> KA;�08 2, PG III, (USEI1 OIL) ERG# 171 EPA/Other <br /> 3 G 2 110 1.1) <br /> E State <br /> o N NC6-1 RCRA HAZARDOUS WASTE LIQUID (AQUEOUSWA=TE) 134 <br /> 66 E EPA/Other NON <br /> N R0 <br /> o T. e Ir+' Gf * V� <br /> 043 ' 15 V sal -.10,State <br /> R EPA/Other <br /> D IM 1011 1P <br /> Ce V State <br /> w d. <br /> H <br /> Z <br /> W EPA/Other <br /> U <br /> W <br /> `n J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Z0.A. 64495-1 a ` b. <br /> W B. E4495-24 <br /> J <br /> 6yy�5•�, a d. <br /> Q 03 <br /> Z 15. Special Handling Instructions and Additional Information <br /> 0 <br /> Q 4 HOUR EMERGENCY PHONE # <br /> Z <br /> W <br /> t- <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 cll respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> 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 /> N practicable and that I flava selected the practicable method of treatment,storage,or disposal currently ovaila61 to me which minimizes the present and future threat to human heolt <br /> and the environment;OR,if I am a small quantity generator,1 have made a rod faith effort to m' imize my waste generation and select the best waste management method that i <br /> W available to me and that I can afford. <br /> OPri ed/Typed No Sign re r Month Day Yi <br /> W T 17. Trans ter 1 Acknowled ement of Recei t of Materials <br /> ixR Si nature t` Month Day Y <br /> W p Printed/Ty ed Nome 9 <br /> W <br /> s ::;j-07C6 p <br /> P <br /> W g raps orter 2 Aknowledgement of Receipt of Materials <br /> 0 P i ed/Typed N me - n/J Si a ure _ - Month Day Y, <br /> V) <br /> Q R <br /> U 9. r ancy In ication t1oce <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or rotor Certification of recei t of hazardous materi Is co red b his man ifesl except as noted in Item 19. <br /> T tint d/Typed Nam n ure f Month Day Y <br /> y D 0a <br /> DO NOT WRITE BELO THIS LINE <br />