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Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I'.Generator ID Number 2.Page I of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST <br /> JJK <br /> 5.Generators Name and Mailing Address Generators Site Address(if.different than mailing address) <br /> RAMOS INC. <br /> P.O. ".401 1515 w <br /> 1WEST SACF�-JAE�JTCJ CA WEST':S�ACPAMEPMO.CA 9,;6391 <br /> Generators Phone;, • <br /> 6.Transporter I Cdffp-57TRM%"^ U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> RAIVIGS ENVIRLWENTAL S31ERVICES IK. <br /> ISIS SOUTH PPIEP P.D. <br /> Facility's Phone*, 1. <br /> ga. 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 Pa I cking Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. <br /> N001 iiC R, !,"%,k�-F.G0 L11--'j �i'f F- L if i�AD k;'j ED 0 iiO <br /> 0 <br /> U <br /> 2. <br /> 3. <br /> 4. <br /> --------------- <br /> 14.Special Handling Instructions and Additional Information <br /> 91311) USED 011-MIXED OIL ERGOW71 <br /> RANDLEIRS TO.BE TRAINEBAND I[JISIE APPIRVVED PPF <br /> 9r"E.5 <br /> 15. GENERATOR'S/OFFEROR'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, <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)gr(b)(if I am a small quantity generator)is true. <br /> Generatoes/Offeror's Pripdfryped Name Signature' Month Day Year <br /> IA <br /> =j 16.International Shipments <br /> 1:1 import to U.S. El Export from U.S'. Port of ant 'it: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> IX 17.Transporter Acknowledgment of Receipt of Materials. <br /> U.) <br /> Transporter 1 Printedljyped Name Signa urej, Month Day Year <br /> 0 1) t, I <br /> Transporter 2 Printed/Typed Name Signald-re Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space D Quantity El Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Zi <br /> Facility's Phone: <br /> LLj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Cn 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLI 1. <br /> 0 . f). I v 1 1 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 /> Phntedrrype5 Name Signature <br /> Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous edifibns are obsolete, DESIGNATED FACILITY'S COPY <br />