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A - <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 17Generatorll)Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST �4 , 1916,371-6747 01991 <br /> 2435 JJK <br /> 5.Generator's Name and Mailing Address Generatofs Slte Address(it different than malting address) <br /> VICTORY RENEWABLES LLC <br /> 91612AVIS AVE <br /> STOCKTON,CA 96203 <br /> Generator's Phon <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES INC. CADD44pp3556 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES INC. CADD"003SSB <br /> 1515 SOUTH RIVER RD. <br /> WEST SACRAMENTO,CA 95691 <br /> Faa7itys Phone:916371-6747 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit 13.Waste Codes <br /> HM and PadaM Group(d any)) No. Type Quantity WtNol. <br /> 1. NON RCRA HAZARDOUS_WASTESOLID.(OIL,DEBRIS) _ — --- -►_ P 3E2 <br /> 0oZ l 12&0 <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special HandDg Instructions and Additional Information <br /> Ml)PRORLES18M ERGM71 <br /> E.R. CONTRACTOR: RAMOS ENVIORNMEdTAL <br /> HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE <br /> 15. GENEtATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledrplaarded.and are in all respects in proper candibon for import according to appli db international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of Otis consignment conform to the terms of the attached EPAAckroMedgment of Carsent <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(d I am a large quantity generator)or(b)(If I am a small quantity generator)Is true. <br /> Generatoes101feroes Printedrfyped Name ' <br /> th Day Year <br /> 16.International Shipments <br /> ❑Import to U.S. El Export from U.S. Port of entry/exit <br /> Transporter signature(for exports ally): Date leaving U.S.: <br /> Cr- 17.TransporterAdmowledgment of Receipt of Materials <br /> 12 Transporter 1 Prin Name Signa Month Day Year <br /> a <br /> Z Transporter 2 Priv Namo Sfgnahae Month Day Year <br /> 1 B.Discrepancy <br /> 1 Ba.D screpancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial ReNectlon ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altemate FacMty(or Generator) U.S.EPA ID Number <br /> U <br /> FaaTity s Phone: <br /> W 18c.Signature of Allemete Facility(or Generator) Math Day Year <br /> Q <br /> Z <br /> V5 19.Hazardous Waste Report Management Method Codes 0.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1• 2. 3. 4. <br /> 1 <br /> 20.Designated FaaTty Owner or Operator.CetOficatlon of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Printedriyped Name Signature Month Day Year <br /> EPA Form 8700.22(Rev.12-17) Previous edif)ons are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />