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10— 2-08; 4:49PM;YELLOW ;913 344 3814 # 29/ 33 <br /> HAZARDOUS WAST MANIFES`. <br /> I NT OF NATURAL RESOURCES ; <br /> DIVISION OF ENVIRONMENITAL:OUALITY THIS DOCUMENT MUST BE USED FOR ALL MISSOURI-pE6TINED 6HIPMENT3„ <br /> Hazardous Waste Program INMUCTIONS FOR THE COMPLETION OFTHI6 FORM ARE ON A SERgRPKAENT EL <br /> I ' P.O.BOX 176 Jefferson City Missouri 65102 <br /> 673.7513116 EMERbENGY V,acoWGUARD CHSMTREC -DEPT NFNA,UMl <br /> I' REa1WN3E. 1.800424 A902 f-0DM1/EI ea00 ,R1aOURCE3' <br /> k Ploan pllrt.m type(Fornntlesignad for use On-61116(12-pitch)typewriter.) . ,Form-:Approved OMB NO 2060.0034 <br /> .UNIFORM HAZARDOUS t Generetoh U6 EPA to Na, - WNW 2 Page;___ Informatioil.ln the*slSaded areas <br /> WASTEMANIFRST OawmamNo. <br /> .. 1' - f i 4 i8(equirodQy'oytdt'0laW..:' ' q <br /> ayeperatdrarlameandMailmgaddmaa, RO UHAY E,PRE,SS,: INCORPORATFD r a <br /> 3233 WOMIS ROAD <br /> STOCKTON CA 957.05. Oki <br /> fi a <br /> s 4 OeheretoYs Phase( 2(�g ) Y <br /> 966-•2901 x1*•� <br /> ! 6.TrenggdOr 1 Comp011y Name 6.US EPA ID Number `" runt <br /> { " HERITAGE TRA1,15FOR'T LLC r WN <br /> 7.11Fensporter2 Company Name S.US EPA ID Number <br /> y. Q <br /> *I B:Dealpnated Fecialy Name fund-Site Address 10.US EPA 10 Number <br /> . ` HERITAGE UWIRONME:NTAL SERVICES LLC ,y a <br /> .8525 NE38T1ISTREET af3 0 <br /> w <br /> KAO AG "fit 1:;1916� <br /> Y.US Dot or Ibn@wledMg Prcper"ahppinp Neme,mrd Clew,ID Numbers Pxpnp Oroup(1lerry))- 12.0ontalnis <br /> Number type Total Unit <br /> Quarldiv. YYWcI '� Z <br /> X-7, FIAMMABLE,LIQUI Sr N.O.S. , 3, n <br /> UNi995, ) GTII OJAINT _ ERG *128 p <br /> a ) l\Q1 1 0. 100 P a <br /> 8r { 12923. PGII' (CAI�M]IJM HS'DRZSltII�•'`r w <br /> t Z <br /> 101AS$IUN HYOR0XIDC C1 <br /> ERG #154 0 1 0 0 3 0 P <br /> , <br /> je <br /> 1ji. <br /> G <br /> t5 pec N fI A{ItlalOnel lni0rmanon - '^"� 'ww �•1-- N <br /> rN"° Eentsyeney Pili la # (800) 326-1221_'' -, <br /> `h W <br /> ta"rq.;ERT1F"A41 her" yAEC14fe1hel(hecbMentsolliisngtoapfiicable luEy'eifddEcWAlelyde�crieEdabaexDygulatiionsAndkAplinrontla4adgulertg dnpact/ed,�r'A'aPhee,ekeyac�l'ey,;� <br /> If l am b a2 respects leproper con811an IORrens11or1 by highway accordng to applicable international end neuonA government regulations ana'applbade state regulat(O. t Q <br /> and are <br /> a large quantity.general",,I consy that I have a progrem in piece to reduce the volume and loxloty of waste generated to the degrce 1 havq rlgtemdned to be eW nomically practicable anp Nat'I'M <br /> i -have selected the pmataaDla nwApotl W treatment,Storage,or disposal curtereyavallable b me which minimizes the present end future threat tit human health andthe"fironma It OR.H Iari a small O <br /> qua NY generator,I have made A load twin effort to minlmize my waste gen.,,on and acted the best waste rpartagententSwood ayalu ble to me that I can alfam. FFa <br /> .. PrN\ Name i `p: `,.\ �aetur`e""' _ Wreh Day Year W <br /> 44r2< < w <br /> T 17 8 'ler 1 ACWwMadge@em of - elpl d MetOrlels -P boo (7 <br /> + :N 'fie S§nalu Month DaY ear Lul <br /> P l ti m <br /> '0 1&Transponer2Ackri4Wgementof Recelptot atvmis bate - D <br /> :;R PrhgeyTypetl Name - - Signature Month Day Year Z <br /> :p <br /> ti <br /> 19' 4crepzhcy,Indcahon Space DWC <br /> - . < LU <br /> 10 <br /> '..A F <br /> T 20.OealgnalOd FaolUty Ovmar Or Operator.Certification of receipt of hazardous materlals covered by thiii mpnlfssl'except.as noted In Sem 1B. Dale ppy <br /> Y Print M _ _. _. F <br /> § ypad Noma Slgnatuie Man_h Da/ Year LU <br /> (R <br /> V. ®q.1', 03 <br /> = t <br /> EM FORM S70Q•22( EV.1.98)MDNR•HWG 1 1 0 PREVIOUS EDITIONS AR OBSOLETE - CONTNN95p%flBCYCLED PAPHI'WHIDH''^ '`• <br /> - ZIM INCLUDES NOT LESS THAN 20% P08T <br />