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AIL Form Approved, OMB No. 2050.0039 <br /> ,se print or type. <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2, Page 1 oT. Emergency Response Phone 4. Manifest Tracking Number <br /> JJ <br /> WASTE MANIFEST 0 0004j"�32 i 5.371 -5747 0 2 4 4 4 5 5 6 2 ' <br /> T. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) <br /> ROSS ISLA14D SM40 & GRAVEL CO. <br /> 10703 HUlIAPHRE YS ST. <br /> STOCICUON, CA %203 <br /> Generator's Phortg03-956" 7 <br /> U.S. EPA ID Number <br /> 6. Transporter 1 Company Name <br /> R,A&(10^u Ejgl ,IFIFtG1-lMENTAL SERVICES INC. CAi�v3v0t7va�5E <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> EnatedName and Site AddressU.S. EPAIDNumberaACIFie �tESuURCE RECOVEF;1° u��3150 EAST PICO KV'0. <br /> LOS ANGELES , CA 90023 <br /> 99.71.15 <br /> gat 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 Packing Group (if any)) No. Type Quantity WL I. <br /> 1 . UN1203 , �IHASTE GASOLINE , 31 PGII G 331 cm 3018 <br /> LU 4 <br /> z 2. <br /> w <br /> 3. <br /> ALI <br /> 4. <br /> q ij44 , � <br /> 0%.1pecial Handling instructions and Additional Information <br /> 9H•1}PROIi ILE,�# ERG #123 <br /> E.R. CONTrsACTOR: RAMO S Ef OORNMENTAi <br /> IHANDLERS SHOULD BE TRAINED A40 USE APPROVED PPE `Z � <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 Intemagonaland national governmental regulationsw 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 gene orA)) (ifI am a small quantity generator) Is We. <br /> Generator s/Ogeror rintedRyped Names Si alure j Month rDay Yegar <br /> AI Lu <br /> T6, International Shipments Import to U.S. ❑ Export from U.S. Port of entry/exik <br /> r" Date leaving U.S.: <br /> Z Transporter signature (for exports only): <br /> SRI <br /> W 17, TransporlerAcknowledgmentofReceiplofMaterials IRANI <br /> uj <br /> Transporter 1 PrintedlTyped'Narn Signature Month Day Y <br /> ear <br /> a G' <br /> z Transporter 2 Printediiyped Name Signature Month Day ear <br /> ANNE <br /> 18. Discrepancy <br />[ 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> AMAMI <br /> 18b, Alternate F.adlity (or Generator) U.S. EPA ID Number <br /> AnalV <br /> W Facility's Phone: Month Day Year <br /> w 18c. Signature of Alternate Facility (or Generator) <br /> a <br /> GUIANA <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> C1 1 , 120 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 /> Printedityped Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. *17) Previous editions are obsolete. DESIGMATED FACILITY TO EPA's eaMANIFEST SYSTEM <br />