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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL0.0 Cy %4 )-- 020444948 JJK 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) ,{ s:t v hl- (09A1,k-r S r��.'G•� •A Generator's Phone: 6.Transporter 1 Company NameU.S.EPA ID Number r RAMOS ERMRONMENT?.� �'ADt'Ue.^�3E.�6 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address^.-.MOS ENIAROW,_ 71CL U.S.EPA ID Number '..A.0044013355£ 1915 SUl1TH RIV R KG. WEST SACRAMENTO,CA. 95691 Facility's Phone�1��'1.574 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total ,2.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt./Vol. 1. NON RGRA. F5ZZ RDOUS tyASTE L1„1010 Q-NL( Sa AIE R) f;-. O f rY Z 2. -D---' LU 3. 6 r 4. 14.Special Handling Instructions and Additional Information Z, 9811 ERGM71 �5 o -1 i-i 4 HANDLERS TO BE TRAINED AND USE APPROuED PPE. F.R. CONTRACTOR: RAMOS ENVIRONMENTA- SERVICES 15. GENERATOR'SIOFFEROR'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 EPA Acknowledgment of Consent. 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Genlerator'slOfferor's PdntedlTypfd Name Signature_ Month Day Year 16. t^ F- International Shipments El Import to U.S. Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials ry Signa)ure 0 Month Day Year Transporter 1 Printedrryped Na1gie O `,' 1:: tj 4.T I CL Z 1- 4 Month Day Year Transporter 2 Print d yped Name Signature 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U rai Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z as19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3• 4. ! II 'II 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Year Printed/Typed Name i Signature � Month Day COPY EPA Form V700-22(Rev.12-17) Pre ous editio re obsolete. DESIGNATED FACI IF YOU RECEIVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e-MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE. -