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mase print or type. I Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. GenemlorlD Number 2. Page i of 3. Emergency Response Phone 4. Manifest Tmckln Number WASTE MANIFEST CA J. 0000 S za 46 , -.,:,, , _s; 10213 3659 JJ K 5. Generators Name and Mailing Add s Generator's Site Address (if different than mailing/'aLddress) <C5 4IC rn -�'1� DIY � � —f'I�c- {}P1^ F' I C 4 GoY f � • SSB rH/T[G Y /� . F-o • PR. S�tz9 roc � , cr9 9�z 1 z_ fir 7 cA 9� 9 57vS Generators Phone: J� 6. Transporter l Company Name U.S. EPA ID Number RAMOS ENVIRONMENTAL SERVICES ING. ORIGINAL GAOD4400M 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number RAMOS ENVIRONMENTAL SERVICES INC. CA0044003666 1515 SOUTH RIVER RD, RECEWED WEST SACRAMENTO, CA 95691 Fac ity's Phoneg163715747 ga 91b. U.S. DOT Description (including Proper Shipping Name, Hazard Close, ID Number, 10. Containers ii. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt./Vol. c 1" NON RCRA HAZARDOUS WASTE LIQUID (OILY WATER) ZL rz 2.. ui 3. 4. I I 14. pedal Handling Instructions and dleoimationER�7 ALERS IQ �� TO 9E TRAINED AND USE APPROVED PPE. 1 E.R. CONTRACTOR: RAMOS ENVIRONMENTAL SERVICES . . 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, aid are classified, packaged, marked and labeled/placarded, and are In all respects In proper condition for transport according to applicable International and national governmental regulations. If export shipment and l 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) (ifI am a small quantity ge erator) is We. Generators/Offerors Pdnted/Typed Name Signator Month Day Year "A Y 13 S WE 14 113 izo 16. International Shipments ❑ Impodto U.S. El Export fro .S Port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: K 17. TmnspoderAgg9ctttknowledgment of ceipt of Materials Transporter 1 n ed/Typed Namf Signature Month Day Year .J/� e h - 9 5E Transporter 2 Prin d. typed Name FSignamw Montle Day Year 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181b. Alternate Facility (Or Generator) U.S, EPA ID Number J U LL Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z S2 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) LUL 2. 3. 4. �0lyl 20. Designated Facility Omer or Operator: Certification of receipt of hazardous materials covered by the manifest except ayAM in Item lila 1 PdnledlT ed Na ,n Signature Month Day Year to n� /5 a a I • EPA Form 700-12 (Rev. 12-17) Previous edifronsareobsolete. DESIGNATED FACILITYTO GENERATOR