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Pease print or type.(Form designed for use on elite(1 2-p typewnter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Cmemor 10 Number 2 Page 1 1 3.Emergency Response Phone - 4.Manliest Tracking Number <br /> WASTE MANIFEST C Ap a000$,S y83 16-3�111-Wa 017145625 JJ K <br /> 5.Generators Name and MaSngAddress eraWs Address P cilerent than maPng address) <br /> ;tbz neral:l�fl SClLoaG DLtAI 40 GtSD-LoDt l whit.saH 0(- <br /> /3c,S is 0WCs'f~7— 3 S. .44 c .9J 1uE <br /> L.aD:, CA, 9ssa5K19-1SZ A- 37Th1' 1) Loi�� G¢, 9S2y2 <br /> Generators Phone- <br /> _ <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES INC. CAOO4100.3555 <br /> 7.Transpoftr2 Company Name U.S.FPA ID Number <br /> 8.Designated Fac9ity Name and Sly Address U.S.FPA IO Number <br /> VEOLIA ES TECMMCAL SOLUTIONS CATM14079 <br /> 1125 HENSLEY STREET <br /> RICHMOND,CA 91801 _ <br /> Facility's Phm8DO-243.23112 <br /> ga. 9b.U,S.DOT Desaiption(mduding Proper%ippiig Name,Hazard Cass,ID Number, 10.Containers 11,Total 17.Unit <br /> I:M andPacNng Gaup Ofany)) No. Type Quantity WLNoI. 13.Waste Codes <br /> s.; <br /> Ix x <br /> o 1.wvsl39, �SrrnS, AW ' <br /> 0 P6n- CcAre: �c -Is,3c� cH ' 5 <br /> w 2uNI�6o, wR5^}E CoPKa5�v6/=n. l p pS, <br /> " x 8, P6z�(sodit• , lLyAeo�c,3c=�maaosfkenr�1 ' / <br /> �r P6a'CScd�.».�, llrySXaKe�j5¢I.7.O..�f{�Gl[(A/4� , <br /> ql <br /> 67 <br /> °kN1943, WAs-F£i/.s�nnu4$/.6 - �,J,67.S,r3 f vD} <br /> xRss�PaArryfl,AlAr�u,0) SAS6FAX -) <br /> 14.Spedal Handling lnsuuctions and AddSonal lnymaem p 56•.1.5 <br /> �jsv- jriro i-p4H-59 Ixss6r4G- 98a) p,�¢.zs'�llss�. LPI.h�-s� <br /> I ' RAM0 EN=WA'L SERVICES '!S'Q�i 1O'�S+I I xss Gs Fft-p 1r <br /> HAtD1.EFW SfOULD HE TRAINED AND USE APPROVED PPE 9By)PSR: LNS S.'L 1 I LIT-SI <br /> 96 fi� 22L5B� E&r15z</f-::S9 /X55646 . s <br /> 15. GENERAMR'SIOFFEROR'S CERTIFICATION:I hereby deflate that the contents of this consignment one fully end emaaelly,dascn'hed above by the proper eNppirg name,and are classified,packaged, <br /> marked and lxbdiedrptscaNed,and are In a3 aspects in proper condition for transport sc ardng to app9ohle International and nab"mal gcvnamnlal regulators.9win shipment and I am the Primary <br /> Expeder,I rnrtly that be contents of trds consignment mnfonn to the tomo of the attached EPAAcknmNedgment of Conant- <br /> I m*that the waste mloiniszton statement IdeneW In 40 CFR 26227(a)(d I ton a large quantity,gene al an(b) m a small generator)Is true. <br /> Gneala' sPdnledR a SgraNre Month Day You <br /> 118 <br /> —, 16.International Sypmens ImPMto U.S. 3 8 <br /> F.. ❑ ❑Furl from U.S. Pod ofentry/sot <br /> z Transporter signature(for exports avy): Date IeaNng U S.: <br /> 17.Tra ul alarAdmawledgment of Receipt of Materials . <br /> Transpoder l PrintedrTyped Name Sgratu Month Day Year <br /> rnsponer2Ponted/Typed Name SgnaeA Muth Day Year <br /> i18.Dsnparwy <br /> lea.Discrepancy Indicator,Space ❑ Quantity ❑Type ❑Revduo ❑Pa thi Re(ec6m ❑Fu9 Rejection <br /> Menllest Reference Number. <br /> 19b.Alternate Faaily(or Generator) U.S.EPA ID Number <br /> V <br /> FaoMys Phone: <br /> u, 194 Sgnatum clAltcmato Faatdy(or Generator) Month Day Year <br /> a " <br /> z <br /> y19,HazaNars Waste Report Management WNW Codes{a.,codes for haranous waste boahnem,disposal,and racychng systems) <br /> C 1. 2. 3. d. <br /> 20.Designated Fao➢ly Owner or Opuata:Cerbllca6u of mcelo of hazardou matelots covered by the mandril exopt as Mad In Ilam tea <br /> PrInhedinryfied Name Signature Month Day Year <br /> EPA Form 9700-22(Ray.3-05) Previous editions araobsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />