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Please print or . .' Form desi ned fdr use ort elite r12 s ter. <br />Form Approved. OMB No. 2050-0039 <br />UNIFORIA HAZARDOUS <br />WASTE NIANIFEST <br />1. Generator ID Number <br />CAL000353`386 <br />2. Page 1 of <br />3. Emergency Response Phone <br />1frfilt�5747 <br />(an" qq T ng unCbw +� ('j <br />fJ.f. 1.�"`i J.MGi�I JiK . <br />B. Generator sone antl Mailing Address Generators Site Address (if differeht than mailing address) <br />BGRt CH RESOURCE RECMIERY CADS; Pt ft Z6 LLC i <br />1WO INDUSTRIAL DR. <br />S` OCKTON. CA 9W9 <br />Generator's P <br />0. Transporter 1 Company Name <br />VA EPA ID Number <br />RAiIM36 EJOARONMENTAL SMVICES INC. <br />GAEi0440F 36 <br />F. Transporter 2 Company Name:. <br />4%8c EPA lQ limrtfier <br />.. . <br />B. Desigrwted FedNly Name and Sfte Address <br />RAMOS ENVIRONMENTAL SMACES INC. <br />Isis SOUTH RIVERFID. <br />WEST SACRAMENTO. CA 956TH <br />Fadll sPhone�1I&Vt,'47 <br />9a <br />9b. U.S. DOT Description onduding Proper Shipping Name, Hazard Clens, ID Number, <br />ti). Containers <br />V 14lbfel <br />yg thdl <br />13YIfaNe t oiM <br />HM <br />andPacidngGroup (if any)) <br />No. <br />Type <br />X <br />1NfNd., <br />d <br />N <br />1. WN RCRA HATit OOLIS WA'SM SOLID PL, DEMIS): <br />QST <br />E1NR a .. ,,.� <br />J <br />F► _. <br />0 <br />H <br />n2. <br />Ei.. <br />J�A <br />. . . . . . . . . . <br />Iff2T8 <br />O <br />4. <br />PE. <br />ISN <br />14. Special Handlinganstrudioneand Additional UformatIon ,,r•� <br />#''�'�� I 'f'.r,�s.�!. ` �,'7ir� <br />_ - . <br />1 jPR'DFit�# .., : , ERGiitfTt � ..: •:,'�•� <br />E.R: CON'TRACTOIt AAMOS ENVIRONf�I WAl� <br />tt <br />HAND SHOULD Be TRAINED AND USE APPRt�D. PPe._if <br />15. GENERATOR'S✓OFFEROR'S CERTIFICATION: I hereby. declare that the contents of this eonslgnmentare fully and accurately described abovabylke`-"ar shipping name, ard.amclesalfied, packaged, .` <br />maiked and-Istieledlplacarded, and are In all respects In proper condition fortrensaort aabrdirg to applicable-Intemadoneland national gammmentai 99one IferglatehlprneM and I am the Primary <br />Exporter, I car* that the contends of this consignment oonform to the term of the attached EPAAckrwMedgment of Consent. ' <br />f ceftlfy thatltis waste mtrieczeUon statement identftled M 4th CFR 282.27(a) (N i ren a large quantity generator) or X (fl I am a small quantity ganeralor) is bus >• 1 <br />.. <br />Generator'e/Oflemts Firinted/Typed Name Slgnshm <br />Month Deg <br />- <br />F– <br />18. Intemational S ents <br />❑Irnportto U.S: LJ Exportfrom U.S.'J ort of entry/exit: <br />` <br />`Transportersignature (for exports, only): Date leaving U.S.: <br />W <br />17. TiansporterAdawMedgprentof Receipt of Materiels <br />:' <br />d <br />Trsrapanter t PrtRMedSr am hi - <br />Montlr .: Qty <br />2 Pr nted/Typed Name r stuns <br />MaiQl <br />ZTransporter <br />t8 IN crel"ancy <br />tSa. Discrepertcy Indication Space ❑ Quanifty ❑7}gre ❑ Residua <br />❑Pedfel 17ejadlon ❑:Fdf RaJadiar' <br />r <br />Manifest Reference Nenber: <br />- <br />t8b. Altsmata Facility (or Generator) <br />U S EPAID Number <br />x <br />t3 <br />1 <br />- <br />Facilitys Phone: <br />a <br />I& Slgnawm ofAltDmate Fa ly w G@nerato <br />OW <br />19 lfa ridetre waste Report Menagerr>ent Mepiod as (I.e., codes for hazardous waste treatment disposal, and recycling systema) <br />13. <br />20. Designated Facility Ow wow Open Eer Cer Catlnr of receipt of hazardous materials oovared by the manifest except as holdA h Item * <br />yped Name Signature <br />EPA Form 8700-22 (Re . 3-05) Previous editions are obsolete. <br />DESIGNATED FACILI'T'Y TO GNMATOR <br />