CORLW5SRC (2) - Laserfiche WebLink

Home Browse Search

Please print or type. Form Approved. OMB No. 2050-0039 4 GENERATOR ) I UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number CA10004229,32 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 021989043 JJ K Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) ROSS ISLAND SAND & GRAVEL CO. 1003 HUMPHREYS ST. STOCKMN, CA ckCPM Generator's Phonem..actg.a-6-7 I Transporter 1 Company Name U.S. EPA ID Number ENVIRONMENTAL SERVICES INC. I --• - - - Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number RAMOS ENVIRONMENTAL SERVICES INC. 1515 SOUTH RIVER RD. CA0044003556 WEST SACRAMENTO, CA 95691 Facility's Phone,g16-371-5747 I ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HMand Packing Group (if any)) No. Type Quantity Wt.Nol. NON RCRA HAZARDOUS WASTE SOUD (OIL, DEBRIS) bA/L 41P-.. P 352 1 002- Soo 1 Special Handling Instructions and Additional Information e)11 37 9E31) PROFILE# ERG#I71 IkerSO4/0 -. , , HANDLERS TO BE TRAINED AND USE APPROVED PPE. .3 t i-d E.R. CONTRACTOR: RAMOS ENVIRONMENTAL SERVICES GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, aid are classified, packaged, 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 I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) ' I a a small quantity generator) is true. Generator'yOf.epalotinted/Typed ....,,. -Z Name Signatu Month Day Year 6,...... R...._ Ci5 0-41„./...... e, (........_____ 1 -7 1271 1'2_d 1- 1 . mational Shipments Import U.S. Export from U.S. Port of entry/exit: to Transporter signature (for exports only): Date leaving U.S.: F5 17. Transporter Acknowledgment of Receipt of Materials TRANSPORTE Transporter 1 Printed/Type Name& , 1 Sign i 6 tr- .1 e i Month Day Year I/ IffLezA 1 7 P tz-ezz Transporter 2 Printed/Typed Name Sig - . Month Day Year I '4- DESIGNATED FACILITY -0- t 18. Discrepancy Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. 1-1 ( 4.1 i 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Name Signature Month Day Year ------ (,...1 (11 A --e---(......, ,../1-1". t.....44.-1,.-.1.-, I ....e I EPA Form 8700-22 (Re -17) Previous editions are obsolete. DESIGNATED F s e-