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State of Califorrio—Emnonmrit.1 Protection Agenc, <br /> Form App owed OMB No 2050-0039(E.p res 930-94) See Instructions an <br /> Plea backOCbackO; '3@ b. Dadme <br /> pom of Toric Substances C. <br /> p t oi'ypa. F cf sipnad for use on ell.(12pitch'y writes Sacramento,California <br /> UNIFORM HAZARDOUS 1. Ge roro oris U$EPA ID No. Manifest Do ument no. 2. Page I Information in the shaded areas <br /> `c e) _ is not required by Federal law. <br /> .WASTE MANIFEST L' S .ler/ of 1 <br /> 3. Generator's Nameand Mailing Address A:Stam Manifest Document Number' <br /> n CUST(kr] RV 9 956434 <br /> 4307 AIRPORT WAY, STQCKTON, CA 95206 B. Ernie G naramr's ID <br /> A. Generator's Phone <br /> O3. Transporter 1 Company Name 6. U$EPA ID Number C. State Transporters ID ��^{. <br /> RAMOS ENVIRON,a1ENTAL SERVICES C1 Al DI 0141410101 5 5 5 D. Transporter'sPhona 916-371-2570 <br /> Q 7. Transporter 2 Company Name 8. U$EPA ID Number +✓ 3 :&,0*14) tsY. <br /> a0 ... y , <br /> V r sporesP �1e TSV'�9 5� <br /> Q <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G..S tW ditty's It <br /> �� RA;MOS ENVIRONMENTAL SERVICES ) � <br /> W-t!L 1515 SOUTH RIVER ROAD, !JEST SACRAMENTO CA 95691 <br /> (,per CAb0440035 <br /> 11. US DOT Description(including Proper Shi Name,Hazard Class,and ID Number 12. C°Mai 3. Total 14. Unit <br /> Z p ( gShipping <br /> p ) No. T ' Ouan1' Wt/Vol 1. Waste Number <br /> /TN3 °/Ybl'V-f�t12A H�rxar ua s e State, /, t <br /> V/N E L17� �� EPA/Other <br /> W N b. Er'13't` -( State <br /> co E <br /> v R <br /> N <br /> A .EPA%Other <br /> CsT C. State <br /> 1 O <br /> d, R EPA/Other <br /> w <br /> F <br /> d' State <br /> !.uJ r .,4 <br /> v1 L <br /> Zditionol Descripigns,for Matarlalsl.lislpd A t i ..„;; , K.°Hd7 <br /> c. � w ea n � <br /> O a ifsjart <br /> 0- <br /> Z <br /> Q 1 S i l Ha d in tr ons and dd f oral Information <br /> USE PR�4�F� AI� PROLECTIVE GEAR, USE STANDARD SAFETY PRECAUTIONS, <br /> z EI�tERGENCY CONTACT # 916-371-2570, 800-456-7745. <br /> w <br /> I_ <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the content of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> .y packed,marked,and labeled,and are in all respect;in proper condition for transport by highway according to applicable federal,state and international laws. <br /> lJ <br /> If I am a large quantity generator, 1 certify that I haven program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> i.I threat to human health and the environment;OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> s., waste management method Mat is available to me and that I can afford. <br /> ' O Prin /Typed Nams p q Signa r �Mlonth Day Year <br /> U Q'/ <br /> Z - T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Printed T ed Na e <br /> (� / yp � 'gnature Month Day Year <br /> ,5 me M )e-s <br /> ui <br /> 0 18. Trons orter 2 AcknowledoeftsInitof Recei t of Materials <br /> u i Printed/Typed Name Signature Month Day Year <br /> O e <br /> w 19. Discrepancy Indication Space <br /> N <br /> VIF <br /> A <br /> Z C <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name • Signature <br /> Y Monts y Da Vea. <br /> !i <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (12/91) To: P.O. Box 400, Sacramento, CA 938120400 <br /> EPA 8700—/22�f/ <br />