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r I Please printortype, Form Approved. OMB No. 2050.0039 UNIFORM HAZARDOUS I . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CALOOD246288 1 316-371 .5747 010 912 019 JJ K 5. Generator's Name and Malting Address Generator's Site Address (if different than mailing address) COUNTY OF SAN JOAQUIN PARKS 11798 N MICKE GROVE RM LODI , CA 95240 j Generator's Phone: 6, Transporter 1 Company Name U.S. EPA ID Number RAMOS ENVIRONMENTAL SERVICES INC. CA0044003556 7. Transporter 2 Company Name U.S. EPA ib Number f 8. Designated Facility Name and Site Address U.S. EPA iD Number RAMOS ENVIRONMENTAL SERVICES INC. CAD0440 W56 1515 SOUTH RIVER RO& WEST SACRAMENTO , CA 95691 Facility's Phone: 916-371 -5747 go, 9b. U.S, DOT Description (including Proper Shipping Name, Hazard Class, ID Number, t0. Containers 11. Total 12. Unit 13, Waste Codes HM and Packing Group (if any)) No. Type Quantity WLNoL 1 NON RCRA HA7ARE)OUS WASTE SOLID (OiL , DEBRIS) -• tom- 352 Sar 2. 1. 4. <° 44b acialNagd]in gIhsUucbonsandAdditionalInformation �y 981 ) PR6FILE# , ERG#i713�� r Fi�4N©tj=RS :T0;8E TRAINED AND USE APPROVED PPE. Eli CONTRACTOR: RAMOS ENVIRONMENTAL SERVICES XcJs 15. GENERATORISIOFFEROR!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 transportaccoiding to applicable inlema lonaland national governmental regulations. If export shipment and I am the Primary Exporter, I cetAly that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the ,waete minimization statement Identified in 40 CFR 262.27(a) (it I am a large quantity generator) or (b) (iff am a small quantity generator) is true. Generator'slOfferoes PdntedfrypedNaame S ature �J Month Day Year 16, International Shipments ❑ Import to U.S. Export from U.S. Pori of en lexis: Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Transporter i PdntedlTyped Name. Signature y� Month Day Year LL QTransporter2 Printed/Typed Name Signature Month Day Year h 18. Discrepancy 18a. Discrepancy indication Space F] Quantity ❑ Type ElResidue ❑ Partial Rejection El Partial Manlfest Reference Number: i8b. Alternate Facility (or Generator) U.5• EPA ID Number 7 LL Facility's Ph": Month Day Year 180. Signature of Altemale Facility (or Generator) i 4 I z 19. Hazardous Waste Report Management Method Codes (Le,, codes forhazardous waste treatment, disposal, and recycling systems) I o 1 • 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receiptof hazardous materials covered by the manifest except as noted In Item t8a PdntedfTyped Name Signature Month Day Year EPA Form 0700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's euMANIFEST SYSTEM