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Please print or type. <br />Form Approyed.OMBNo.2 039 <br />�In <-Irl raaamuaameonsare Oomlem. DESIGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />UNIFORM HAZARDOUS <br />1.Geneatmlp Nembm <br />ILR000130062 <br />2Pagel of <br />+ <br />3. Emerganry Resparae Phone <br />900.424-9309, "1" <br />4.Manlfest T,., Number <br />1006581423 G BF <br />WASTE MANIFEST <br />5. GenmaWrs�aalxM.t�a ILW���lean,LLC Gmemar�Seflgageea-88drysiaiean�°�.�) . <br />2175 Point Blvd, Suite# 375. 4370 Abso)ut Avenue <br />Elgin, IL 60123 877-939-7948 Frosne, CA 93725 <br />Genealors Phms: <br />6.Teanspotlerl Carepany Name U.S. FPAID'"Me" <br />Heritage-Crystal Clean, LLC ILR000130062 <br />7.TranapmWr2Campmy Name US.EPAIDNu et <br />6. Des6ya fol Fad4ty Nara aW SiloAtltlresa U.S. FPA IO Numter <br />Liquid Environmental Solutions of Arizona <br />5159 West Van Buren Street <br />Phoenix, AZ 85043 - 602.278-3442 AZR000030432 <br />Faalilys Pl . <br />9a <br />9b. U.S. DOTwscrmOm(IrltladiM Pmpereupping Name, HassNClesa, lO Number, <br />10.CanlMeaea <br />11.Tow <br />12 Ua1 <br />13. Was@Codes <br />No. <br />-Type <br />HM <br />aec PmoWng GmW(lfagr) <br />closely <br />mrya. <br />Ed <br />1' NON-DOTIRCRA REGULATED, (AQUEOUS PARTS CLEANER) <br />DR <br />G <br />223 <br />IQ� <br />z <br />z <br />w <br />3. <br />4. <br />14. Spmal Handim <br />9b.lII¢WdonamtlAddiOorellnlonalbn <br />1 130213184 9b.3) <br />9b.2) 9b.4) <br />15. GENERATOR'SrOFFEROR'SCERTIRCANON: Ihembytletlare WlNa smWMsdWs consgarenlere ludyantl aavatetydesub�aborebyfhe pmpmaNppWg name, mtl are dasUf gpadmgeq <br />madted andIaheleNPlxzNeq and areal all,aspxle N proPer mM9Nn for 4mapml aozMHg b apolraMe International and w0ma gcwo n efa re9WaMee, If aapml sNVmml and I am Me Primary <br />Fnlpodar,Iamity Met Me conlenta of NB oanegrmenl ombm to Mer one of Me aeehad EPAAd fedgmenl of Consani. <br />I coNy that We waste mWmaason aWWmenlldngf dIn 40 CFR 26221(.) N l am a ergo ImIty geremtal or 1) 1111 em a amall 9um11 ge"Meml "we, <br />GamenlarWAemrs NoMilryped Nams - SgreWa Month Day Year <br />Kv13� CID tMrZ - vel 09 103 1 w <br />r <br />1fi.lnlmmtona S10pian6 ❑ImPIWUs. ❑Expodlmm U.S. PMormtyfet <br />i <br />TrenapoleragnaWrelloreaorWaay): OetpleaWrq LLS.: <br />rK <br />17.TaIu'poNerPtlmwAadgmwddReceglal MaMrWs <br />t2 <br />Tanspeder 1 PrhleWTyped Name all <br />MmM pay Year <br />a <br />(Z%i%31zw I GomelVA <br />QMW4 0 a3 a0 <br />rmmpMm2PrWledayPed Name — sgrewre WnM pay Year <br />} <br />19.Die.wo, <br />I <br />I&.DlsmepamylropuMan SP ❑ sena, ❑Type ❑Realdpe ❑Pada RGedm ❑FWRaiedm <br />Manifeelfeafere.Number. <br />(^ <br />18b. Alemale Faallity(or Gmeetor) U.S. EPA ID Nmrber <br />V <br />u <br />Fadlilys Phone: <br />,war <br />18a SigmWre ofNeanale Fadty for Gmm Mq <br />Menta Day Year <br />6 <br />2 <br />h19. <br />llzzmdeua Waste Report Management Wool Coda, Se.. codes far hasaNms waste M chard, dopeal, mdaaors, eyahma) <br />1. <br />2 3. <br />4, <br />20. Desgnted Fadity RNnm m Sparse, CaNrraywn of reW,I.f as Moes malmlals mremtl by Me MoMeed eacopt a a ndW M Ilam lea <br />PmledlTyP N—Name Slgnalme Month Day year <br />�In <-Irl raaamuaameonsare Oomlem. DESIGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />