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Please print or type.(Form designed for use on eats(12-pitch(typewriter.) Forth Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.GeneraurlD NuMaz 2Pagelof 3.Ememwq Response Rune 4.Manifut Tracking Numba <br /> WASTE MANIFEST CARS 056'`1 63 I A 1017145623 JJ K <br /> 5.Generators NameaM Addrue <br /> �e l 'e�gisS 3%-flys Aa77J; iWil; I L-qDi a, 15,241A <br /> 6.Transporter 1 Carpany Name U.S.EPA to Number <br /> RAMOS ENVIRONMENTAL SERVICES INC. ICAU04400.3555 <br /> T.Transporter Company Nerne U.S.FPA ID Number <br /> a.DesVeled FadlyMarne and Site Mdress EOUA ES TECHNICAL SOLUTIONS TIONS U.S.EPA ID Number <br /> 1128 HENSLEY STREET CATOB0014079 <br /> RICHMOND,CA 94801 <br /> FaOWS Phanp'243'2= <br /> 9a, 9b.US.DOT Desco0on(kzWding ProperShiON Na.,Hazard Close.ID Num, 10,CooWmers 11.TOW 12 Unit 13.Waste Codes <br /> HM end PaddvgGW Pony)) No. Type Quenaty WtNaL <br /> 1 jf�0A1� F�A'Zf}�-35Ow5 t+.7 Rr$ <br /> of �6$rC.:Sc w,+N WA'f6r�Sor¢pytp/1-joi�E�6C4 <br /> �P Drr) ax7 <br /> 2-,JbAl 7PC eA P-4Z-40Z0 4-5 LtASI� soGZn <br /> 3 p <br /> yl'I 102 1 <br /> 3;Jonl7ee.2E+1fA'I/he]bus (4JYfS`(gsr !.— .- 1 <br /> 4 AtJo �ctpq {{!}z�4fLDcn�cb T,rJAS <br /> eALW+, -scL','F 1 D 40 <br /> 14.Special Har&V Inshudo s and AdOonat Inlormabon <br /> Bel)PROFILE# ERGSI�I Y���i 4V 'E-2 o�x/23 /t7�s5s/off/56 ZZ <br /> ER CONIRACTOIt RAMOS EMARONMEWALSERVICEs 963) p,Ca('CS�I�'1102 ifzLm-y9 f-A;*/tel <br /> HANOLERS SHOULD 13E TRAmm AND USE APPROVED PPE i 4.P-1'F}-$$ S724C,r 1)CSS <br /> 98`U <br /> 15. GENERA70WSIOFFERORI CERTIFICATION:I hereby dedambat Me content days corugrmed arefully and amnaWy desmbedabovebydA proper stopping name,ardaredasslAed,pedo*, <br /> marked and hbded?pbcarded,and are hate respects in proper mrdbon for transpMacrndln9 toappac"intemaaaalaod national govammenW req.Jatiors.H rvyott sh¢xnenlaM I am the PMwy <br /> Exporter,t rerffy that to content dads mrsigrmcot.0am to au tones of VA alddud EPAAdamledgawn!of Catsent. <br /> I mfity tat tm waste anknlrnaon statement fdenafod In 40 CFR 262.27(a)(II I am a large quanMy generator)or(b)(a I am a wW qu3nM gauiatm)B bue_ <br /> Geraaur sPmktllT S Month Day Year <br /> VG <br /> 18.Iritematlanal SNpmenla <br /> F ❑torpent U.S. ❑Expert hart U.S. Pandanbyleob <br /> Tmnspwef WWW ra(forer?Xe o*): Date leaving U.S.: <br /> w 17.TmrsporterAdmow1edgrlwntd Recd Materials <br /> OTransporter 1 PmIaTyped Nana p ( 51gna Monte Day Year <br /> Q 2 PnImeNTyped Name Monte Day Year <br /> rr <br /> t— <br /> tla.Discrepancy <br /> 19a.Dimganq InSxation SPS ❑ OuantltY ❑Type ❑Residue Rat <br /> ❑PaNal Rel�4an ❑full action <br /> Manifest Reference Number. <br /> 1 alemde FaoSty(or Geneatr) U.S.FPA M Number <br /> J <br /> U <br /> rai. FacSys Plena: <br /> w lac.Signature of Alternate Facity(or Gxeatnr) Month Day Yaor <br /> a <br /> m19.Ha2xdous Wast RepotMaagemenl Medmd Codes(Le.,codes for ha=ximss wase treatment disposal.and mcydag systems) <br /> 3 4. <br /> 20.DaslgmW FacMy QVWWOperator Catlficatgn of m"of hoardous materWs covered by aM maNled ucept as noted M Hem 1 a <br /> 1 PmuNTyped Name Skpwtue Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editfoasare obsoiete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />