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r <br />III <br />N <br />r <br />G <br />.anmsmld Proteclien Agency <br />�r,Io. 2050-0039 fExpinm 9-3049) <br />ape. form dmigmd for v e on eliM (12-pikhj 1. iron. <br />S82 IFISITUCf10DS OR back of To b' Department of Toxic SubstancesControl SnrmmeaM !'n <br />DO NOT WRITEIELO THIS LINE.\ <br />white: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 87700-22 <br />DISC 00Il/99) To: P.O. Box 3000, Sacramento, CA 95812 <br />— <br />UNIFORM HAZARDOUS <br />Ga r abr s US EPA ID No, Manifest Documem No. <br />2. Page l <br />Informmimi in the shaded areas <br />WASTE MANIFEST, <br />CAL 0 1 2 5 4 8 C� <br />is not required by Federal law. <br />0 0 5 S. 3 <br />1 of I <br />3. (imam w , Nome and Moiling Address <br />b:; SfaWManRmP Decumem Na nim, - - <br />SAN JOAQUIN COUNTY MOSQUITO & VECTOR CONTROL DISTRICT <br />20070593 <br />0 <br />7759 S. AIRPORT ROAD, STOCKTON, CA 95206 <br />s�siob Gsa.rotorl0 <br />A. Gemma/s Phare 12091 982-4675[IS11-1i'll <br />III III T <br />5. TromporM 1 Company Near 6. US EPA ID Number <br />$oMTmrssporm?viD.fRemuved;(-.- <br />O <br />m <br />- <br />ENVIRONMENTAL SERVICES CAD 4 4 0 0 3 5 5 6 <br />U::Tiwhaporte/s PHena' <br />TL'----'C916)'37I-5747 <br />7. Troispertm 2 Company Nome 8. US EPA ID Number <br />E. Sfine Twnaporhls ID Reserved.),. <br />T.umporlet'e <br />F. f Kaye <br />g <br />9. Designated Facility Name and Sib AM. 10. US EPA ID Number <br />RAMOS ENVIRONMENTAL SERVICES <br />GC <br />x <br />1515 SOUTH RIVER ROAD, WEST SACRAMENTO, CA 95691 <br />tf..Fanh — <br />CAD 0 4 4 0 0 3 5 5 6_ <br />(916) 371-5747 <br />j <br />I1. US DOT Devi ion (including Proper Shipping Name, Hamad Clow, and ID Number <br />W' I' 8 P^ PP nre I <br />12. Contoimms <br />13. Total <br />14. Unit[ <br />- <br />No. <br />T <br />QuantityWt/Vol <br />4 WaateNvmbm <br />L <br />E <br />0. <br />NON—RCRA HAZARDOUS WASTE LIQUID <br />Stab 223 <br />G <br />(OILY WATER) ERG00#171 <br />4- <br />EPAfOtx N/A .' <br />E <br />D N <br />b. <br />EPA/Other . <br />R <br />e A <br />, — <br />i T <br />`' <br />,Start_,. <br />o O <br />EVAq/CMAev <br />= R <br />L <br />4 <br />d. - <br />State _. <br />J <br />EPA/Olher <br />- <br />J. Add'tronalDescriptionfbkMartial,Ums,&Abova-.,.: <br />IG,:Nad1-_q 46des-for Waetas Usladkbove <br />ok p <br />15. Special Handling Instructions mid Additional Informative <br />HANDLERS BE 40 HOUR OSHA/SARA TRAINED S' o 892 <br />AND USE NIOSH APPROVED PPE. <br />EMERGENCY CONTACT: 916 371-5747 <br />i <br />16. GENERATOR'S CERTIFICATION: I hereby, declare thin the contents of this consignment are fully and accurately described above by proper shipping name and am classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national <br />gammmeat regulations. <br />If I am o large quanfiq generator, I certify that I have a program in place b reduce the volume and toxicity of wash generated b the degree 1 have determined M be economically <br />practicable and that I= selected the p 'cable method of treatment, storage, or disposal carrendy mailable to me which minimizes the present and furore threat to human health <br />and the environment; OR, if I am o ,malI tity ganerahr, I harm made a good faith effort b minimize my wash generation and sslect the best waste management method that is <br />mailable me and that I can affo <br />Printed/T me <br />Sig^a:'jLA-- <br />Month Day Year <br />4 � <br />M7 <br />Trots Mr 1 Aeknowlad ement of R of Munn s <br />A <br />R <br />Printed/T Name ig^ <br />Meath Year <br />5 <br />P <br />; <br />R <br />I8, wledgembint of Receipt of Materials ' <br />T <br />Prinhd/Typed Nome <br />Sigw6nre <br />E <br />R <br />7Ywr <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I1 <br />20. Facility Owner or roro rtificmi F rearm of haz^rdovs martial, <br />covered b <br />tried i I 19. <br />T <br />Prinbd/Typed N <br />Bignaturo <br />L��.t <br />Monlb Day Ywr <br />Y <br />\� <br />k <br />05 <br />DO NOT WRITEIELO THIS LINE.\ <br />white: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 87700-22 <br />DISC 00Il/99) To: P.O. Box 3000, Sacramento, CA 95812 <br />— <br />