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i IIIIU VIII Illll lu��,�II Illil lllll hill VIII till Illllli Ililll II IIII Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Fonn Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackln Number WASTE MANIFEST C L000263335 3 (800)326-1221 M273116Wa5 s.c�RR't1em1 41ftil�ddrtVERSE LOGISTICS SPECIALIST /Gl -"T I RE Q1ga i LEAD/REV. LOG. 2800 NAGLEE RD. 2800 NAGLEE RD. TRACY, CA 95304 TRACY, CA 95304 (^c09)833-3494 GEN: 1c2961 Generator's Phone: 6.Transporter 1 Company ame U.S.EPA ID Number HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 7.Transporter 2 Company Name U.S.EPA ID Number WE 71/ r� T`kA1 e✓ OKO IF V 8'�6yf 'gNnVJr TAL SERVICES LLC U.S.EPA ID Number 284 E STOREY RD AZD0817o5402 COOLIDGE, AZ 85228 Fadlity's Phone: (520)723-41671 ga I 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Ouantity Wt.Nol 13.Waste Codes X RQ UN1057,WASTE LIGHTERS,2. 1 (Du�11), I n 331 DC)��1 _ 11'ERG#1�5 OE" DR +(/ LU x 2. RQ,UN1950 WASTE AEROSOLS, FLAMMABLE, n D001 331 N.0.S. ,2. 1, N01),ERG#1'26 (> Y 3. - X ES r 9�f r X 4. 7 14.Spec al Handling Instructions and Additional Information 111 7 1.Wlc_0512109_LDR 2.W7_Q512104_LDR c _ 11327258315 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping narne,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)If I am a large quantity generator)or(b)(If l am a small quantity generator)is We. 7atils/Offeroes Print yped Name gna Month Day Year _..r 16.Wernational Shipments F- ❑Import to U.S. ❑Export fr U. . Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials w IX Trans er Printedfiyped Name gna r ay Year d ZnKkC �ct ai Q sporter 2 Printrld/Typed Name Signature Mon ay ear 11 18. isaepancy 18a.Discrepancy Indication Space 11 Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. IZ 16b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q Facility's Phone: W 18c.Signature of Aftemate Facility(or Generator) Month Day Year Q Z Fn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1 H141 T- H 141 3. - a. -H+4+- 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdnted/ryped Name Signature Month Day Year !'K.9,� EPA Form 6700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)