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Nov . 30 . 2018 0 : 27AM No . 2278 P . 2 <br /> Please print or type. (Form das(gnod for use on alit9 (12-pllch) Wewdleh) Farm Approved. OMB No. 2050.0939 <br /> UNIFORM HAZARDOUS 1. Generator ID Number p 2, Page of ;3, 8murgEmc;yRaspans9PhDm) anif ist ack] u{m� +ear <br /> WASTE MANI[ E8T + 2 2,'�0Q15V5Cil397 J JK <br /> 6, Genetalofs Name and Melling Address r1 ( etor s Bile Addreas (}f diIfaronl fan malftng addrese) <br /> t,01) Gi - til 21 'fi J1 2.t�44W f w U IV <br /> SIN qsw <br /> General 4 Phone: <br /> 6, Transporter 1 Company Name U.S. EPA ID Number <br /> RAM08 ; NVIRONMENTAI, SERVICES INC, CA004d0035% <br /> 7, Transporter 2 Company Natna U,$, EPA ID Number <br /> B. Oeaignated Facility Name and Vie Address PACIFIC RESOURCE RECOVERY U,S. fiPA ID Number C <br /> 3150 EAST PICO BLVQ- <br /> LOSANGELES, Cts 90023 <br /> rHM <br /> n/# Phone: <br /> 8b. U.S. DOT DsscAplian (including Proper $hippigq Name, Hazaid Gass, ID Number 10. Containamr 11, Total 12- UnU 1$, Wae(e Codes <br /> and packing Group (Many)) No, Typo Quantity Wldvol, <br /> ll� / , C7 � ! yS�+ <br /> 417 <br /> ;y r e� ,+r q <br /> 1 f l r�445 V tJ�� Cil 1, tiJ w i-, <br /> 2. } <br /> 1� <br /> r I <br /> i <br /> s, 0 r i <br /> it <br /> 14, Spsdal Harndtiog Instructions end Addftional Information <br /> 081 ) PROFILE* ERiG#l71 <br /> E.R. CONTRACTOR: RAMOS ENVIRONMENTAL SERVIC58 Scr# <br /> HAN13LERS TO III_ TRAINED AND USE APPROVED PPE, <br /> 15. G@NERATOW81OFFERORVS CERTIFICATION: I harehydeclere that the conl9nle of this consignment are fusty and accurately described above by the proper shipping name, and are dassiffed, pacdreged, <br /> marked and labeled/placarded, and ere in all rospacis in proper condkn for transport According to applicable International and national govommeniat regulations. If export Shlpaumt and 1 am the Primary <br /> Exporter, I certify (tai the con(ents of lhfs cons(gnment conform 10 0,10 terms of Iha atlachsd EPAAcknowladgmant of Consent. <br /> I Wily that the waste minimization atslemenl fdeni fled In 40 CFR 262,27(x) (if I am a large quaniftygenerelor) sr (b) (t(t am a smell quantity generator) is Inca <br /> GenerstofslORer j/Pdnledffyped oma 8i nalure Month Day Year <br /> VWQssssssss l <br /> —+ t , niomationa Ipmenis Export from U.S. Ponofon loxit: <br /> � ❑ Importto U,8. ❑ po try - - <br /> Transporter signature (for exports only): Date lawng U.S.: <br /> 17. TraneparterAdinotvtedgmenl of Recelpl of materials <br /> Transporter 1 Pdp4sd Typed NameILL,� Signa Month Day Year <br /> O \1 +y <br /> aley Ile <br /> Transporter 2Prinledify Nq/ Signatu Month Day Year <br /> F <br /> 16. Discrepant ��--}} <br /> 18s. Discrepancy Indication Spero © 4uandry 1:1 7M 1....1 TResidue ❑ Partial Re)soffon ❑ Full Rejection <br /> Manliest Reference Number. <br /> 18b. Aiternate Facility (or Generator) U.S. EPA ID Number <br /> v <br /> W KaaiMYS Phone: <br /> tdu 18c, Signature of Alternate Fool i(y (or Generator) Month Day Yoar <br /> H <br /> 19. Hazardous Waste Report Management Method Codes (I.e., codes for hazardous waste tmatmanl, disposal, end recydurg systems) <br /> 4 i. 9. 4. <br /> 2. <br /> 20. Designated Facility Owner or Operator: Cer88cadon of recelpl of hazardous materials Covered by the manifest except as naiad in Item lea <br /> PrintedlTyped Noma Slgiria(ure Monthay Teir <br /> EPA Form 87DD•22 (Rev. 3A5) PreviousediGansate obsolele. SY`3Rfr t ;a't` c , : n ;II i')'y +31 r01°lNA) 14 N 1l�lt (IF RE tl1 !! ©) <br />