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fp _ <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID N ber 2.Page i of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C J42149 1 1 1916--371-5-74,7 1 JJ K <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> LODI GAS STORAGE-ACAMPOI „*. ",MYFk-,�61- f1) <br /> P.Q. ROX230 tars r re <br /> .AC.Ad�IF'G.CAACA:Pv1F'Ct,C:4 95220Generators Phon <br /> 6.Transporter 1 Company ane U.S.EPA It)Number <br /> PAMOS EMIRONMENTAL SERACES M. `--` " " CAD544003656 <br /> 7.Transporter 2 Company Name U:S.EPA ID Number <br /> 8.Designated Facility Name and Site Address " r 1: C, U.S.EPA ID Number <br /> RAMOS•EWRONMENTAL SERLACES INC <br /> 10515 SOLMi RIVEN RD. <br /> WEST SACRAIJ ENtO,CAA 95691 <br /> FacTy'sPhone:16'371-5147 <br /> ga, 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 WLNIA <br /> t <br /> NON RCRA HAZARDOU& WASTE SQUO (OIL, DEBRIS) P 352 <br /> Z 2. <br /> W <br /> 3. <br /> 4, <br /> 14.Special Handling Ynstnactions and Additions#Information <br /> 981)PRGEtil WW IERGfF171 <br /> E.R. CONTRACTOR_ Rokill ENVIIROMMIENTAL SERVICES <br /> 1ANDLERS SHOULD BE TRAINED :AND USE APPROVED PPE 'f�y <br /> 15. GENERATOR'SIGFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fu11y and accurately described stove 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 international and national governmental regulations.If export shipment and t am the Primary <br /> Exporter.I cer* a contents of this consignment conform to the terms of the attached EPA Acknowledgment ofCone t. <br /> 1 ce0y that tripe" a minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) ' ntity generator)is true. <br /> Generator's s Pdntedlryped Name Signature Month Day. Year <br /> 16.In al Shipments <br /> ❑Import to U.S. ❑Export from U.S. -'lP of entrylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17,Transporter Acknowledgment of Receipt of Ma"W.,----, <br /> Transporter 1 PrintedlTyped Name L <br /> Signature Mom Day Year <br /> I <br /> aza Transporter 2 PrintedlTyped Name Signature Month Day Year <br /> E� <br /> t- <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue Ll Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA iD Number <br /> J <br /> U <br /> LL <br /> Facility's Phone: <br /> Lu 18c.Signature ofWtemate Facility jor Generator) Month Day Year <br /> a <br /> 1g.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 12. 3. 4. <br /> 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manliest except as tided in Item 18a <br /> PrinledlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev. -17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br />