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i <br /> If <br /> 1 <br /> I <br /> Please print or type, Form Approved. OMB No. 2050.0039 <br /> UNIFORM ItIAZARDOUS <br /> I . Generator ID Number 2. Page f of 3. Emergency Response Phone 4, Manifest Tracking Number ��// <br /> WASTE MANIFEST CAt000248288 1 916 8715747 019912242 J R <br /> S. Generator's Name and Mailing Address Generator's Site Address (If different than mailing address) <br /> COUNTY OF SAN JOAQUiN PARKS <br /> 11793 N MICKE GROVE RD. <br /> LODI , CA 95240 i <br /> i <br /> Generator's Phond '�53'7 i <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES INC. CA0044003M <br /> 7, Transporter.? Company Name U.S. EPA ID Number <br /> • I <br /> 8. Designated Facility Name and SlteAddress PACIFIC RESOURCE RECOVERY U,S, EPA ID Number <br /> CAODM252405 <br /> 31150 EAST PICO BLVD. <br /> LOS ANGELES, CA 9DD23 <br /> Facility's Phone WD*499.7145 <br /> 9a. 9b. U.S. DOT Description (Including Proper Shipping Name, Hazard Cless, ID Number, 100 Containers 11 . Tolal 12. Unit 13, Waste Codes <br /> HM and Packing Group Of any)) No. Type Quantity Wtivol. <br /> i . UN1325 , WASTE FLAMMABLE SOLID ORGANIC , NOS , 4. 1 , PGIII 4116 ^ P 352 DD01 0018 <br /> p (GASOLINE , DEBRIS) <br /> w 2, _ <br /> 3, <br /> 4. <br /> 1;. Special Handling Instructions and Additional Information <br /> 98.1 )PROFILE#6 ERG#133 <br /> OS ENVIRONMENTAL <br /> HANDLERS SHOULD BETRACTOt MTRAINED AND USE APPROVED PPE <br /> 15. GENERATORWOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, erd afe classified, packaged, <br /> marked and labeledfplaoarded, 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 EPA Acknowledgment of Consent. <br /> I cedtfy that the waste minimization statement Identified In 40 CFR 262.27(a) of I am a large quantity gener (fit 2!=, uanity generator) is true. <br /> CGenerator'sfOBeror's Printe arne SIgnatur Month Day Year <br /> r <br /> t <br /> 18. International Shipments <br /> Impart to U.S. ❑ Expo from U.S. l� Pod of enlryJexit: <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> 04 17. TranspoderAcknowiedgment of Receipt of Materials <br /> Transporter 1 Printed d Name Signatur t Month Day Year <br /> O /o. <br /> 2 Transpoder2PrintedfTypbd NamAL Signature Month Day Year <br /> P. <br /> 18. 01screpahcy <br /> 18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Fug Rejection <br /> Manifest Reference Number. <br /> 18b. Alternate Facility (or Generator) U.S. EPAID Number <br /> V , <br /> U< Facility's Phone: <br /> 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> LFG <br /> j; 19. Hazardous Waste Report Management Method Codes (I.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ' LIJ 1. 2. 3. 4. <br /> 20, Designated Facility Owner or Operator: Certification of recelpt of hazardous materials covered by the manifest except as noted In Item 18a <br /> 3i <br /> Pdnte (Type Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIPESY SYSTEM <br /> r: <br />