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- i <br /> Please print or type. Form Approved. OMB No. 2050-0039 <br /> UNIFO HAZARDOUS i Gen�eerator ID Number 2. Page 1 of 3. Emergency Response Phone 4, Manifest Tracking Number <br /> WAS, ' MANIFEST 0000 n "0 1 916-371 -3'47 04: 0793876 JJK <br /> S. Generators Name and Malin Addle Generators SileAddress (if different than malting address) li <br /> - r vtv � f' 71� 4errt tit_ 4r� ' ?4ta` q2i? 15F • Ufa- .yy�es � 400 <br /> til Generators Phone: 9S/ 3 y5raa2 <br /> 6. Transporter i Company Name U.S. EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES INC . OWGIN CAD04401MM56 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> MAY <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> MDS ENVIRONMENTAL SERVICES INC. ` <br /> Isis SOUTH RIVER RD.WEST c� <br /> WEST SACRAMENTO, C0. 95691 <br />! Facility'sPhone:916371-5747 <br /> ga 9b. U.S. DOT Descriplion (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers. 11. Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity Wl.NOI. <br /> I <br /> j I- NON RCRA HAZARDOUS WASTE SCUD (OIL, DEBRIS) 0611"L 352 <br /> w <br /> Z Z. <br /> W <br /> 3. <br /> t <br /> I I <br /> 4. <br /> I <br /> 14. 5 ectal Handlin Instructions and Additional Information <br /> 61) PRO I" ERGIII d lirq � �/G� 2_ o i�, S '7 ; <br /> HANDLERS TO HE TRAINED AND USE APPROVED PPE, <br /> E.R. CONTRACTOR: RAMOS ENVIRONMENTAL SERVICES <br /> Zx cY6 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: Thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and Iabelediplacarded, and are In all respects in proper condition for transport according to applicable International and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I minify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent. <br /> I cediy that.the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quaintly generator) or (b) (ifI am a small quantity generator) is two. <br /> GeneratoeslOfferoes PrintedRyped Name Signatur Month Day Year <br /> Y a S we a E3 z0 <br /> F 16. International Shipments ❑ Import to U.S. <br /> El Export from Port of enirylexil: <br /> Z Tromportpf signature (for exports only): Date leaving U.S.: <br /> W 17. Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Prin encs d Name Signalum,. Month Day Year <br /> a ! /. t L3 Z o <br /> z Transporter 2 Printed ypedN e - F Sfinalil Month Day Year <br /> 18. Discrepancy , <br /> 18a. Discrepancy Indication Space El Quantity ❑ Type ❑ Residue. 1 ❑ Full Re <br /> ❑ Partial Rejection lection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> V <br /> LL Faclliys Phone: <br /> W 18c. Signature at Alternate Facility (or Generator) Month Day Year <br /> i <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> G i. 2. 3. 4. <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdnteirfyped Name Signature Month Day Year <br /> 2.CJ iN LA <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TOG N R <br /> I <br />