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3 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response one 4,Manifest Tracking Number <br /> WASTE MANIFEST Q ,,2Qj49 1 91&371-574? 10181 4 919 5 JJ K <br /> S.Generator's Name and Mailing Address L E C �,' orator's Site Address(if different than mailing address} <br /> LtODI GAS STORAGE-,4,cam t7 f � <br /> P.0, MY 2XI 23265N~'99 <br /> ACAfu P0,CA 95M <br /> Generators Phon <br /> 6.Transporter 1 Company NameS.EPA ID Number <br /> RAMS Edd°�4Rr?tdP�tEI�fTAI SERi�1GES INC, GIII t. �# +y378 <br /> 7.Transporter 2 Company Name ju U S.EPA ID Number <br /> 8.Designated Facility Name and Site Address S.EPA ID Number <br /> i,vftdrl�'IS Et+H.'1RC►lui�PlTr'�L;�R`;AtKES it4t. Y 1Z 40- =t���,.��'�: <br /> 1515 SOUTH RIV1ER R.D. <br /> WEST SA.CPAMIE iTt),CA t1 <br /> Fadlitys Phone:916-371-5747 <br /> ga, 9b.U.S.DOT Description(ineluding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11-Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(If any)p <br /> No. Type Quantity Wt./Vol. <br /> 1. ON KORA.I1AZAADOJS WASTE WJUO (O!L, DEBRIS) � 1 � p 352 <br /> NON <br /> a LJ 1 <br /> x <br /> Z z <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information <br /> 981)PROFILE# F-PG-f171 <br /> KkNOLERS TO BE TRAIL D AND USE APRRO`vED PIPE. }� <br /> �� <br /> E R. Ct)N RAVOi?: RAMOS ENIAR�tft MENTAL SERVICES r 4/ <br /> 15. GENERATOR'S10FFEROR'8 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 Iabeledlplacarded,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 cortify 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)or(b)(if I am a sri ntity generator)is true. <br /> Generatoor sss/OOffffferor's Printedlfyped Name Signature t Month Day jYYeearr <br /> 107- 113 1 <br /> -J 16,International Shipments <br /> 1-- ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> Ix LU <br /> 17.TranaporterAcknowledgment of Receipt of Materials <br /> rTracisporter 1 PrintfTy m Signa e + Month Da Year <br /> A%A �v,s <br /> QTransporter 2 PrintedlTyped Name re Month Day Year <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b Aftemate Facility(or Gonerator) U.S.EPA ID Number <br /> M <br /> to <br /> u- Facility's Phone: <br /> LO 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 1 2. <br /> 111 � k 3. 4. <br /> 20.Designated Fatality Owner or Operator:Certificaton of receipt of hazardous materials covered by the manifest except as noted in item f8a <br /> Printed/Typed Name Signature_.. Month Day Year <br /> EPA Form 8700-22(Rev.3-05) P vious editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />