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Please print or type.(Fan designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t.Generator ID Number Z Page 1 of 3.Emergency Response Phone 4.ManNat Tracki Number <br /> WASTE MANIFEST GAG(�2&ro8 39q 1 916 371-5747 0060`65835 JJK <br /> 5.Generators Name and Mailing Address Generelpfs bila Morass(it wrinenl than mailing address) <br /> 1764P0"-h' Sao /psi Aactic c� s7— <br /> CIL 1 <br /> CIL1r sz bra 9sLa-s <br /> S� TC`7�h ¢.sV- .ti X03 <br /> Geraratoors Phone: a3=S L10 9v% ,isSO <br /> 6.Trmasi 1 Comp Name <br /> U.S.EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES CAD 44 003 556 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Numbe0r <br /> S.Designated FadYty Name end SXeAddrass U.S.EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES <br /> 1515 SOUTH RIVER ROAD, WEST SACRAMENTO, CA 95691 <br /> Fecal sPhone: 916 371-5747 D <br /> gam 9b.U.S.DOT Dewrption(Including Paper Shipping Name,Hsxerd Class,10 Number, 111.Contalnan 11.Total 12.UnitHM and Paddrg Gmup(dNo.eny)) Type ji Ouantlty WI.Nd. 13.Waste Codes <br /> NON-RCRA HAZARDOUS WASTE LIQUID 22 <br /> (OILY WATER) Qb T� <br /> w v <br /> z 2. <br /> w <br /> 3. <br /> 14.SI4. <br /> wal Han[Fingtiabudans and Additional Information 9b1) ERG#171 <br /> SIU f� OG <br /> HANDLERS TO BE TRAINED AND USE PPE. <br /> 15. GENERATOR'8/OFFEROR'S CERTIFICATION:I hereby dsoare Nat Xie contents of this consignment are fully ant accuri desoibed above by Me paperahippirg name,and am dasslfied,paduaged, <br /> marked and labeled/placarded,and are in all respects M proper candiou for banmxt according to applicable international and rational gommmenlal regulations.If export shipment and I am the Primary <br /> Exporter,l badly Nat Me amems of Ih it wnsigronem conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 1081 ity that Me waste minimization statement identified M 40 CFR 262.27(3)(d I am a large quantity general y)or(b)(fit am a smalquantity rear <br /> Generald'sl01temrs 'n Name Signatum Monty Day Year <br /> J <br /> To.lnlematimaSh - cow c G G C <br /> El import to U.S. L1 Export from U.S. Port Of entry/exit <br /> Tmnsprbr sgnsaae(ler expons only): Dab leaving U.S.: <br /> w 17.TranspatarPdooAkdprantofRscaplof s <br /> Transporter 1 rr typed Name <br /> SgnaMre ) Month Da Year <br /> CL r,/ v, r / 6 y <br /> .2a Transporter 2 Primedrtyped Name Signature <br /> � Monts Day Year <br /> } 18.Discrepancy <br /> 18a.Disarepamcy Indication Space ❑ Quante ❑Type ❑Rte. ❑Partial Rejection ❑Full Rejecfion <br /> Manifest Reference Number: <br /> 18b.Nfemab Fad6ty(a Generelar) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fac9M/s Phan: <br /> W l8c.Signature of Alternate Fadity(or Genarebr) <br /> Q Monts Day Year <br /> z <br /> w19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous wade trezunent dsposal,and recydirg systems) <br /> O <br /> it <br /> ' 2. 3. <br /> 4. <br /> 20.Designated Faddy Dourer o Oprelar CMffc tion of receipt of hazanamrs matarals cowed by Me manifest except w nded in Rem 18a <br /> Nae signature Manor Day Year <br /> EPA Form 8700 <br /> -22 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />