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I l Please print or type. Form Approved. OMB No. 2050.0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 1 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST �� J 04116 !5 Oil , _ _ 020390683 JJ K 5. Gepne/ratoes Name and Mail inrg Address /),1 j %3 e i tf (1 � � �� penelator� Site Address (if different than mailing address) Generator's Phone 6. Transporter 1 Company Name U.S. EPA ID Number RAMOS EI'VIROMAENT& GFORVICES tK . V.40(iAdtmCmi �m 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address RAMOS EfdVIRC"MENTAL SERVIGES INC . U.S. EPA ID Number 1515 SOUTH RIVER RD. GACxl4ADCus�+' Vti'EST SAGRAJAENTO , CA 95691 Facilitys Phone: 91 &37145747 ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containare 11 . Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) Ni . Type Quantity WtJVoI. L NON KCRA HAZAKDOM3 WJ�QTtJ { "r' ) U 213 Z 2. to 3. 4. I 14 . Special Handling Instructions and Additional Information 0 d I 1 . l1 tAJ4LXERS TO fife ItiJIMED AND USE APPROV1ED PPE , F. COMRA.GTOR : RAMOS EWIRONMENTHL SEMACES 15, GENERATOR'SfOFFEROR'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 International and 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 EPAAcknowled�flflm, ent of Consent. I certify that the waste minimization statement Identified in 40 GFR 262.27(x) (if I am a large quantity generotdr) or (b) (if l am a smal quantitygenerato is true. Generator'slOfferces Pdnte yped Name ftnatu MD* Dai Year 16. International Shipments E ❑ Import to U.S. EJ Export from U.S: Port of entry/exit: i ? Transporter signature (for exports only): i Date leaving U.S.: W 17. TransporterAcknowledgment of Receipt of Materials LU ji Transporter 1 Pdntedrryped ame Signature Month Day Year IL z9 Transporter 2 PrintedfTyped Name Signature Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity El Type 1:1 Residue ❑ Partial Rejection El Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number J C) Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1 . 2, 3. T7� 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prinied/Typed Name Signature Month Day Year EPA Form 8700.22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY I