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IlllllflllAVIII ilillllNllllIIIIIIfllll11111lIfll!!IlIIIIIIIIi <br /> Please print or type.(Forth designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 1 Generetor ID Number2 Page�3Emergeoncy Response Phone 4.ManHesl Trackln NumberWASTE MANIFEST CAL000263335 30)326-1,221 4a 7�7 72WR <br /> 5.Generator's Name and Mailing Address Generalor's S le Address(if different than mailing address) <br /> TARGET—T07-28 / REVERSE LOGISTICS SPECIALIST / TARGET—T0738 / EXEC. TEAM LEAD/REV. LOG. <br /> 2800 NAGLEE RD. 2800 NAGLEE RD. <br /> TRACY, CA 95304 TRACYCA 95304 <br /> Generators Phone: (209)833-3494 GEN: 1229E 1 <br /> 6.Transporter pang Name U.S.EPA ID Number <br /> HERITAGE TRANSPORT, LLC / SIGNAL HILL IND058484114 <br /> 7.Transporter 2 Compan me US EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> HERITAGE ENVIRONMENTAL SERVICES LLC <br /> 284 E STOREY RD AZD081705402 <br /> COOLIDGE, AZ 85228 <br /> Facility's Phone: (52:10)723-4167 <br /> ga 9b.U.S.DOT Descnption(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11 Total 12.Unit <br /> 13 Waste Godes <br /> HM and Packing Group(if any)) No. Type Quantity WIIVol <br /> 1 _ <br /> o Xr tu., d#?Tri,�df�STEL—ci rizf!'S <br /> Z 2.UJ i <br /> X RG! UN1950 WASTE AEROSOLS FLAMMABLE, <br /> N.O.S. 2. 1, (H-01),ERG#126 I } <br /> f <br /> 3 <br /> X RID,UN1978,WASTE PROPANE, 2. 1, (DC.)01 1,ERG#115 2, <br /> Z III <br /> 4 <br /> 14.Special Hand:ing Instructions and Additional Information <br /> 2'.W7 0512104 3.L•t8_Q5121 f�5_LDR 4,�ieL]7_n51=1 1 r, <br /> , Sj�� <br /> 2C 7 K- C13173211G <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations If export shipment and I am the Primary <br /> C <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowtedgment.of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(f I am a srrkill quantity generator)is true. <br /> Gene or 0 eroi's Printed y ame gna Month ay ear <br /> j 16.International Shipments <br /> F ❑Import to U.S. Export from U S Port of entrylexil <br /> Z Transporter signature for exports only): Dale leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> WL <br /> W Trans iter nnted/Typed Name gnaturc crit ay Year <br /> 0 CL <br /> c. <br /> ZTransporter 2 Prin ype Name Signature Month Day ea <br /> W Q d ( d <br /> 18.Discrepancy <br /> 18a Discrepancy Indication Space Quantity F1 Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Q <br /> t1 Faaf s Phone: <br /> w 18c.Signature of Allemate Facility(or Generator) Month Day Year <br /> H <br /> a <br /> Z <br /> 019.Hazardous Waste Report Management Method Codes 0.s,codes for hazardous waste treatment,disposal,and recycling systems) <br /> D 1 2. 3 4. <br /> •-}rr1 H141 H141 <br /> 20.Designated FacAry Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in IttN t8a <br /> Pnnted/Typed Name � Signature Month Day Year <br /> a� o 09 <br /> EPA Form 8700 22 ) Previous editions are obsolete. IGNATED F ITY TO DESTINATION STATE(IF REQUIRED) <br />