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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST {•.y v4 01 ' "" fk 4 JJ K 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) tv MOS :8EI?"ACES ff-4G. 1515 E RIVER RD. P.O.i. 61DX 4.01 ti y�.Yt �� t, s1NIPST SACRAIWENrC3,'.,A %6q'1 T S,ti t3��+tENTt�i, :.w �s�91 Generator's Phone;.,,.;._,.; ,.-.,, y, 6.Transporter 1 Company Nam"e " U.S.EPA ID Number e vWOSP ENVIRONMENTAL SEiRVI ,ES 11410. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number RAMOS ENtARt.OMENTAL.SE§ZVIGES INC. Cf.0044t0',5.55 1515 SOUTH RIVER R0. WEST SACRAMENIT0,CA 96691 Facility's Phone:-,:�I F-:3;'1-f47 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wl.1vol, 0 1' NON RCRA 'bkZAP.GD JS WASTE I..1QUiD (USED h-5 F EEZ.E) � t � L c� 3. 4. 14.Special Handling Instructions and Additional Information 2811 t35 ED AhTiFREEZE EROUS#6171 �50 rz'.� E-R: r 04TRAGTOR: RA&AOS E VIRONNIENTA1. SERVICES HANDLERS 'SH0U1.0 IBE TRAINED .AND USE APPR(T-ED PPE 15. GENERATOR'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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifl am a small quantity generator)is true. rneralors/Offeror's Printed/Typed Name / Signature Month Day Year ,j 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials 11-- Transporter 1 Printed/Typed Name Signature W--, r Month Day Year n !,. (,r,f ( f,� ,,',:7`°, ,r f,�'ti" ` (_.n ` r_�',y, %q_ U) Transporter 2 Printed/Typed Name Signature Month Day Year H 18.Discrepancy 18a..Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J s U Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 0 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal;and recycling systems) 0 1. 2. 3. 4. • t'q 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as need in Item 18a Printed yped Name `r ;;; Signature f" �. Month Day Year EPA Form 8700-22(Rev.12-17) Previous editl s are obsolete. f'' r` DESIGNATED FACILITY COPY IF YOU RECEIVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e-MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE.