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I�feasapOnt or type. (Form designed for use on elite (12 -pitch} <br />typewriter.) Form Approved. OMB No. 2050 0039 <br />UNIFORM HAZARDOUS 1. uer• eratDr U3 'umber 2;Ps�jof 1. EEerqencyRespmse Phone Manifest Tracking Number <br />--i 7w��'of - 1'* AnA I AIMAIJAq <br />trArormu,rLwj-zzjmev-.-ua) <br />10388.1712 <br />Z3 <br />WASTEMANIFIEST <br />I CAD98234325(800)326-1221 <br />5. %.Na gd MOL <br />1p III Address (if different than mailing address) <br />1010 LL NEift 1288 / LP MANAGER SEARS FULL LINE # 1288 LP MANAGER <br />SEAR <br />* <br />5110 PACIFIC AVE' 5110 PACIFIC AVE <br />STOCKTON, CA 95207 STOCKTON CA 95207 <br />Generators Phone: - (209)475-6500 GEN: IM23 <br />U.S. EPA ID Number <br />41tir -D <br />6. Transporter I company Name Adv Le CAernical -a r*rf wo. 6 70 Sy 0 <br />HeR?"K =KRO&T, <br />T Transporter 2 Company Name U.S. EPA 10 Number <br />AGA I t 4 <br />—0�esigrtated Fdbility Name'arutW Address U.S. EPA ID Number <br />HERITAGE ENVIRONMENTAL SERVICES, LLC <br />5122 EAST STOREY ROAD AZD081705402 <br />COOLIDGE, AZ .85228 <br />FaciftYs Phone. (520)723-4167 <br />9a. <br />9b. U.S. DOT Description (including Proper Shipping Name, Haiard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Code . s <br />NO. <br />Type <br />HM <br />and Packing Group (it any)) <br />Quantity <br />Wtival. <br />X <br />11OW-70 POW <br />Z <br />2. <br />LU <br />CD <br />x <br />X <br />RG UN1993 WASTE FLAMMABLE U )N.O?S., <br />3, PGI (PA I itQU I DS) (DOO 1) , ERG# 128 <br />DA <br />11goo <br />pool <br />4. <br />X <br />—140"'Instructions and Rlditional InWMon <br />3.W5 0458789'LDR 4-.-We--@450%4-4w9W1V� <br />[1147556]G' <br />15. GENERATOR'SOFFERORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described aboveby the proper shipping name, and are classified, packaged, <br />marked and WeWplacarded, and are In all respects in proper condition for transport according to applicable international and national governmental regulations. I export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (it I am a large 22!!tMrator) or (b) (d I am a small quantity generator) is true. <br />Generatoes] s nn e <br />I TA - <br />Monffi Day- *. Year <br />10 `l ®O 10,5 <br />-j <br />I- <br />16. international ShiPmentl 0. <br />Elimport to U.S. Of errd�lexit: <br />Lr <br />Trams r s!Eature fore on k—/Date R'MU-S-: <br />LW17. <br />U <br />Transporter Acknowledgment of Receipt of Materials <br />Ve-8 <br />O~2 <br />Transpo I PrintedfTyped Name Signature Month Day r <br />0 <br />CIL <br />.1041 016 <br />Transputer 2 Signature V %..oe Moran Day Year <br />112 <br />-1QS <br />18. Discrepancy <br />118a. Discrepancy indication Space ❑ Ouanfity El Type F-1 Residue El Partial Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA 10 Number <br />• <br />Uj <br />ftmb,�.mete Facility (or Generator) Month Day Year <br />!F( <br />Z <br />a <br />jS <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />UJ <br />1. <br />2. <br />4 <br />H141 <br />4"1- <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />SignatureMonth Day'rear <br />X <br />Ler-fp&P* <br />trArormu,rLwj-zzjmev-.-ua) <br />10388.1712 <br />Z3 <br />