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i s State of Ca' Protection Agency II ' <br /> ` Form Approved aMb No.2050-00.'i9(EspiMs 9.30.96) See 1-istrvetions on bci 7age b, Department of Toxic Substances Com <br /> Pleme prig or type, form daiprwd for tar on rfer(!? rnrrn/er. I Sacramento,California <br /> UNIFORM HAZARDOUS <br /> 1. Gerserator's US EPA ID No. Manifest Document No. 2. Page i Information in the shaded turas <br /> of / <br /> WASTE MANIFEST I' is not required by Federal law. <br /> L <br /> '" � I <br /> O 3. Generaso�s Name and Mailing Address <br /> I <br /> �Lntar, ,c',4�I pI c�I �l{i� D"�M:�•,+7a`rai':^n�'.rrp:o-,T�o:t.�od.rnl•aVk�'-ss"o4�P�e=the <br /> Minn. <br /> 1.•: t7p . �.''s1�-ti=:A{t^x�,l•fi'hI,�A <br /> ++ _ -'s Y <br /> S- Transporter i Company Name C::. <br /> .SIme6, UEPA ID Number <br /> i !RAMS ENVIRONMENTAL <br /> 9 s` "2�, �iv� SA,c/� : » �� - y � <br /> 7. � A <br /> S��'F�•'3rt-.*�- <br /> .. <br /> Transporter 2 Company Name 8. US EPA ID Number E StaleT s ID :< <br /> 'I tn+ <br /> �' Q t ' i, I LIF Yc!xi)aslesrt_F!hase <br /> 9. Designated Foci Name and She Address 10. US EPA ID Number Cs_State Eocs811sr ID r� azo �t H it <br /> RAMOS ENVIRONMENTAL SERVICES <br /> O&o 1515 SOUTH RIVER ROAD, WEST SACRAMENTO, CA 95691 1 H r '>aP n7. <br /> rs .- <br /> r , .< D 0 14 14 !0 0 �3 15' 1 6 <br /> �r E Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Numberl �} 12. Containers' 1 13, Total 14. UniF <br /> n ` , 'ir�Na i T ! Quantity Wt/Vol C-W6sts <br /> G EPA/Gttse <br /> IE i <br /> N <br /> LoaIs. <br /> Q I I i l I j C4 R tea <br /> A <br /> n T C. <br /> -.tY R I}t 1 EPA(�0Nsar s s r'� <br /> Ui <br /> I 1i <br /> Z d• it i stile. > <br /> W 1 II Ef A/tadrer'rt r <br /> I 11I I I I 1 �Twp r,r.. <br /> Q of .r t iC K-Handl'xsg Codes for Wastes anted A6ore-=•r R <br /> <el <br /> LU <br /> M <br /> ci <br /> 1S. Special Handling Instructions and Additional Information CJ(>�k <br /> Q HANDLERS BE 40 HOUR OSHA/SARA TRAY ED / T`' 6 <br /> w AND USE NIOSH APPROVED PPE. <br /> EMMGENCY CONTACT: 916 371-5747 1r <br /> I 16. GENERATOR'S CERT1119CATION: I hereby declare that the contents of this consignment are fully and accurateiy'described above by proper shipping name and are classified, <br /> Jpocked,marked,and labeled,and are in oil respects in proper condition for transport by highway according to applicable international and notional government regulations. <br /> If I am a large qua"generator, I cerfify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J , <br /> d ecornomieally practicable and that!have selected the procticable method of treatment,storage,or disposal uirentfy available to me which minimises the present and future <br /> v threat to human health and tine amirarrnentr OR, if 1 am a small quantity generalor, I have mode a d fo -,i to minimize my waste generation and soled the best <br /> s: <br /> waste method that is awilable to me and that I can afford, <br /> Prir ped Name Sig to Month Day Year <br /> `U <br /> L T 17, i Ac of Receiet4hateirials <br /> A P3 me /Typed Name. Signokur Month DayYkar <br /> IRS <br /> 1 5Q <br /> 'U p 18. T 2 Ackrsowfed f Receipt of Materials i <br /> U <br /> T Pmw)rTt re 1'i Month Day Year <br /> E <br /> yped Name 19. Discrepancy Indication Spore t� <br /> U A I; <br /> r7 C <br /> 1 !'4 <br /> L <br /> I 20. Fadfity Owner or Operator Certification of recti of hazardous materials covered by this manifest except as noted in item 19. <br /> T Prkrted/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS; LINE." <br /> It <br /> L'-A <br /> White: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> TSG 8022.9 {1/931 To: P.O. Box ..21 Sacramento, CA 95812 <br /> 9700-22 ' <br /> i <br /> '•I <br />