Laserfiche WebLink
ase print or type. ( Form Approved ONE No. 2050-0039 <br /> i Generator IU Number 2. Page i of 3 Emergency Resp Phone 4. Manifest Tracking Number <br /> UNIFORM HAZARD®U3 , } ri <br /> � <br /> JJK <br /> WaSTEMaNiFEsr � � J� C� ¢ ,, �e 7 <br /> 5. Committee Name and Mailing Address Generators Site Address (it different than mailmg address) <br /> DIV � G P6 1 � v1 � � ° v .� , <br /> psiot <br /> µ 7 <br /> Generators Phone: <br /> 6: Transporter I Company Name U.S. EPAID Number <br /> RAhVS EPRgRO l5N`1A,L SEFMCES IN CA3A;f9 i56 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address " U.S. EPA 10 Number <br /> RAi ENVIRONMENTAL SFRVIC ..' INC <br /> 1515 SOL" FH 9pi Ra. L-£ ,CEI 'E <br /> 4aJi SACRAMENTO , CA. 955691 <br /> .Facility's Phondil&3715747 ''.... <br /> gm 9b. U.S. DOT Description (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 QuanOty WLNoi. <br /> 1' NON RCRA R62ARDOUS WASTE LnU1D (OILY WATER) <br /> 2.W <br /> 3. <br /> 4. <br /> 14. Handling Instructions andAdddi�ti�on�al Information <br /> fo <br /> Mi <br /> TO BE TRAINED AND USE APPROVED PPE- <br /> E.R. .CONTRACTOR: RAMOS ENVIRONMENTAL SERLACES <br /> - 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents al consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> 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 I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAACknowledgment of Consent. <br /> 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 asmall quantity geerator) is We. <br /> Generators/Offerors Printedrryped Name 8ignaNr Month Day Year <br /> � Y 13 SWE14 1 Z3 izo <br /> ifi. international Shipments <br /> 11 Import to U.S. - ❑.Export lro .S Port of enirylexih <br /> ? Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. TmnsporterAcknowledgment of ceipt of Materials <br /> a. Transporter 1 11 edityped Name y .. Signature Month Day Year <br /> 129211( <br /> ZZa Transpmter11PH d/Typed Name - Signatur Month h y year <br /> r <br /> 18.Discrepancy <br /> 18aDiscrepancy Indication Space ❑ QuanBly ❑ Type ❑ Residue ❑ PaNai Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> , . 18b. Alternate Facility (or Generator) _ - - U.S. EPA ID Number <br /> .J <br /> Facility's Phone: - <br /> W ll Signature olAltemate Facility (or Generator) . - Month Day Year <br /> Q <br /> Z <br /> y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> hit l <br /> 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except a ed in Item 18a <br /> Printed/" ed Na ,n Signature / Month Day Year <br /> 00 <br /> EPA Form 700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />