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Please;print o�type. r oral designed for•use oil t,lite I2-oitci� n)ewr!te!. – – A -�.�a f o�in Appro����;.OMB Pilo 2U�� -0009 <br /> —� 1.Generator ID Plt!rnber .2..Page'i of 3.Emergency Response Phone ; ,�'ar.boas��iacyin;l Number r <br /> y 16-371 X747 ! 'I _ ;3 i-_ _� �K <br /> A <br /> t1I111FORM HAZARDOUS <br /> WASTE MANIFEST 00306 _ <br /> 5.Generator's lane and Mailing Address — —Generator's Site Address(if driferer t than mailing address) <br /> RAMOS OIL CO,-THORNT> S VV THORNTOi+1 RD, <br /> PO BOX All ATTN:-JOY IKACHADORIAN THORNTON,CA 96646 <br /> VILEST SACRAMENTO,CAI9i ;i <br /> Generator's Phon4iR.,ft,y3Yn <br /> 6.Transporter 1 Company Name U.S.FPA ID Nh mber <br /> RAMOS ENVIRONMENTAL SERVICES iNL, 1 CADOa•i0G�55F ! <br /> 7.T'ranspg'ter 2 Company Flame U.S.EPA ID Number i <br /> S.Designated Facility Name and Site AcldresU.S.GPA ID Nurnber <br /> sPACIFIC RESOURCE RECOVERY CAD008252405 � <br /> 3190 EAST PLCO 8LVD. <br /> LOS ANGELES,CA 9003 <br /> ii <br /> Facility's Phone_ X7145 <br /> 9b.U.S.DOT Description including Pro er Shipping Marne,{-hazard Class,ID Plumber, h '10 COntalnerS ! <br /> 9a. P (including p' pl 9 — I I.Total 12.Unit -i 3.Wasie Codes <br /> t I' <br /> Hitt and Packing Group(if any)) No. TQuantuy Wt/Vol. <br /> ype —t _- <br /> 1. L�iE,•3,PGM 1 0001 0018 <br /> LLJ <br /> 0 :I <br /> I <br /> I <br /> rt, , <br /> 14.Special Handling Instructions and Additional Information ,- <br /> 1)PROFfLEAtIZdSoO�f <br /> ERG*126 <br /> E.R. CONTRACTOR. RAMOS ENVIRONMENTAL <br /> HANDLERS SHOULD 9E TRAINED AND USE APPROVED PPE <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare'that the contents of this consignmeni are fully and accurately described above by the proper shipping narne,and ata 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 shiprneni and I am the Primary <br /> Exporier,I garb. that the contents of'this consignment conform to the terms of the attached GPA Acknowledgment of Consent. <br /> I certify ihat the waste minimization staternent identif ed in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(if I am a small quantify generator)is true. <br /> = Signature <br /> Month Day Yaar <br /> nerator's/Gr`ferdr's Printed/Typed yped Marnezxz�l <br /> j — <br /> ge , <br /> -j 16.International Shipments <br /> -^ ❑Import'to U.S. ❑Export fror�n U.S. Port of ent!ylexit: <br /> m 1, i ransporier signature(for exports only): Date leaving U.S�-=-- <br /> i( ranspor ter Acknowleclgrneni of Receipt of MaterialsLU <br /> _ ___ -_ <br /> _ _ . --� 3 --Si nature -- y :—_� __F_felon h Day Yaar <br /> Transporter'l Printed/r yped Name g - <br /> ri <br /> ��� t <br /> I ransporter 7_Print yped Marne J Mdnth Day ea <br /> _ Sicnaiura r <br /> -� <br /> { <br /> M.Discrepancy F II Rejection <br /> - <br /> a'r 8a.Discrepancy Indication Space ❑ Ouantiiy El Type ❑Residue ❑Partial Relec'Lion ❑ u Releci i <br /> _ <br /> Manifest-Reverence Number: <br /> Ob.Aliernaie Facility(or Generator) U.S.CPA ID Nu!nber <br /> Facility's Phone: <br />