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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1,G 2.Page 1 of3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST est 1 16,371-6747 1 017145974 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) RAMOS OIL CO:STOCKTON 1535 NAVY DR. PO BOX 401 ATTN:JOY KACHADORAIN WEST SACRAMENTO.CA 95591 STOCKTON•CA 95203 Generator's P 6.Transporter 1 Company Name U.S.EPA ID Number RAMOS ENVIRONMENTAL SERVICES INC. CAD044003556 7.Transporter 2 Company Name U.S.EPA ID Number Lo C 1/Gvti j, lav G 6.Designated Facility Name and Site Address PACIFIC RESOURCE RECOVERY U.S.EPA ID Number 3150 EAST PICO BLVD. CA0008252405 LOS ANGELES,CA 90023 Facilitys Phone.SDO'499.7145 9a. 9b.U.S.DOT Descnp6on(inducing Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(h any)) No. Type Quantity WtNol. 13.Waste Codes 1. UN1203,WASTE GASOLINE,3,PGII G 331 PWI 4018 0 -- r -- LU I z 2. L i 3. 4. i I 14.Special Handling Instructions and Additional Information 98.1)PROFUB9i 170Gfi00?j7 ERGM28 E.R. CONTRACTC R: RAMOS ENVIRONMENTAL HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE 15. GENERATOR'StOFFEROR'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 labeledfplacarded,and are in all respects in proper condition for transport according to applicable International and national govemmental 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(11 a all quantity generator)is true. Generator's1Ofremes Printed/Typed Name Signature Month Day Year —r 16.international Shipments Export fro Port of en z ❑Import to U.S. trylexit Transporter signature(for exports only): Date leaving U.S.: L=1 17,TransporterAcknomledgment of Receipt of Materials Transporter 1 Prinied/Typme gn re Month Day Year '�- Z T ns erg PrintedflypedName Signature Month Day Year / GL C� j I-A 18 Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number J U rQi Facilitys Phone: w 18c.Signature of Allemate Facility(or Generator) Month Day Year Q Z v0i 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) i 1 y ; (0 1 2. 3. T. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name '&' ,j "M, � 1 lir 1 I E. Z� I� Signature Month Day Year 1 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNAT FACILITY TO DESTINATION STATE (IF REGUIR D)