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.1S t.e of California—Environmental Protection Agency <br /> Form'AP6roved OMB No.2050-0039(Expires 9.30.99! See Instructions on be f page 6. Department of Toxic Substance <br /> Y'.Aecs, print or type. Form designed for use on elite(12 typewriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1• Generotor's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST 7 / is not required by Federal law. <br /> r r - 1 4 a - �J of <br /> %3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> 2,283-71 <br /> INLAND P°:P INC. (020-TRACY) <br /> o PO BOX 1 12`� TRACY, CA 9a�7F B. State Generator's ID <br /> LO 4. Generator's Phone r ) <br /> N 5. Transporter 1 Comp.4WC Wine '37 1 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> to <br /> ao <br /> o HERITAGE L RALISPGRT, LLC / SIGNAL H T D. Transporter's Phone <br /> e O 7 1v li) c 2 141214L <br /> 1-,g-? 5C[--A 'nr4 <br /> CP 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.], <br /> Q �'• r fJ Q` Z 6 3 �' F. Tronsporter's Phone/ ,2f�—Y O- <br /> C U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID ` y <br /> Q <br /> cy)Z HERITAGE ENVIRONKENTAL =:ERVICEG, LL H. Facility's Phone <br /> coo 5122' EAST STOREY ROAD <br /> 7i 12. Containers 13,Total 14. Unit r <br /> U I 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity WI/Vol I. Waste Number <br /> Z a. State <br /> 110 XT RCRA HAZARDOUS W4STE LIQUID, H O.S. , 9, X2`1 <br /> 3 G NA3082, PG III' , (USED OIL) ERG# 171 EPA/Other <br /> •` E <br /> o Eb. State <br /> 0 E NON RCRA HAZARDOUS 'ASTE ';CLIC' (OILY ABSORBENTS) ?21 <br /> EPA/Other <br /> v R Olt aim X <br /> v A 0=, <br /> C. State <br /> C0 p NODI RCRA HAZARDOUS WASTE SOLID 1I.O.S. , 9, EIA3077, 221 <br /> R P G III, (OIL FILTERS) ERG# 17 f 0 1 � EPA/Other 'JO_ <br /> LU d. State <br /> t— <br /> Z <br /> LU <br /> U EPA/Other <br /> LU <br /> V) J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above. <br /> Z <br /> O A.. 64435-1 a. O! b 03 <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> O n <br /> Z 24 HOUR EMERGENCY PHONE #: l D ;co <br /> LU ` <br /> 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 /> < marked,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,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 economical <br /> d practicable and that I have selected the rocticable 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 smo I quantity generator,I have made a good faith effort to inimize my waste generation and select the best waste management method that <br /> ae available to me and that I con afford. <br /> 0 <br /> } Pre /Typed Nam c Sign re i Month Do Y <br /> Z O -e e I K6 <br /> w T 17. Trans o er 1 Acknowledgement of Receipt of Materials <br /> R <br /> LU a p e SigMonth Do Y <br /> Uj <br /> W 0 1d. Transporter 2 A knowled ement of Receipt of Materials <br /> TP yped Name Signet a Month Day Y <br /> W <br /> < R Q7E&ZI �i <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C. <br /> I <br /> L <br /> 120. Facility Owner or Operator Certification of receipt of hazardous materia e i a esle t i <br /> T P&nth Day Y <br /> y— <br /> Fhg <br /> ' <br /> DO NOT WRITE FLOW THI LINE. <br />