COMPLIANCE INFO_2023 - Laserfiche WebLink

Home Browse Search

Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3,Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000456484 1 916-371-5747 022995606JJK 5,Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) LODI UNIFIED SCHOOL DISTRICT MAINTENANCE&OPERATIONS 880 N GUILD AVE LODI CA,95240 Generator's Phone: 209-331-7186 6.Transporter 1 Company Name U.S,EPA ID Number RAMOS ENVIRONMENTAL SERVICES CAD044003556 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number RAMOS ENVIRONMENTAL SERVICES CAD044003556 1515 S RIVER RD. WEST SACRAMENTO CA,95691-0000 Facility's Phone: 916-371-5747 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WLNoI. 1,non RCRA hazardous waste solid(oil,debris) 0 1 DM 95 P -- — Q 352 LU W 2 0 (- 3. 1 I 4. f ' 14.Special Handling Instructions and Additional Information Line 1: 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, 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)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name bignature Month Day ear 08 1 04 2022 J 16.International Shipments F 11 Import to U.S ❑Export from U.S. Port of entry/exit: Transporter signature for exports only): Dale leaving U.S.: WL 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Signature Month Day ear 0 08 04 2022 a U) Transporter 2 Printed/Typed Name Signature Month Day Year Q F 18.Discrepancy 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J U LL- Facility's Phone: w18c.Signature of Allemale Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1, 2. H141 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year john villanueva I john villanueva 08 05 2022 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM