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Please print or , Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1 1.Generator ID Number �/ 2.Page 1 of 3.Emergency Response Phone ManNest Tricking Number WASTE MANIFEST dAl.000'1$f0q$-1 9113-3?1"374' F022831455 JJK 5,Generator's Name and Mailing ss Generator's Site Address(it different than malting address) Loa;wsp �»A+7� 61nlA+Jrc6 n oro opsea_kr, eso A��Gse.r 4�idre Ph�orro' `5� d/— 8r6 0.Transporter 1 Company Name U.S.EPA ID Number Ramos Environmental Services Inc. IC A D 0 4 4 0 0 3 5 5 6 7.Tra porter 2 Company Name U.S,EPA ID Number 3 lv 0.Designated Facility Name and Site Address U.S.EPA ID Number Ve011a ES Technical Soiutions Richmond 1125 Hensley St Richmond CA 94801 Fadli 's Phone: .2 98. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12,Unit 13,Waste Codes HM and Packing Group(K any)) No. Type Quantity MAW. '+ r3��yt, 4rq maid: l aeos,,s.i� I Doll UJ 2.L"tubo was{ Cameos vii 4�,..c�,,a.o.s yB,Qb�c x01b 4- c me aHAIIIII 1�t soGie..y��o,� ) 1 ( 6! TLW 313%WAS-Ig 0 a.l,Wt��WRs�� [.i,Q.c�c1,rJ�o•3'>.�si � loll 33, �l C�si�e•eth jcy'�� n q�2�d6� ' D� ' 14. a Han ng Instructions and Additional Information 81)PROFILE# HANDLi=-RS TD dE T-,A;NcD;,ItiD USEAPPROVED PPE i=�#r=r-r E.R.CVNTRACTUK; RAMOS ENVIRONMENTAL"� ,j�f..,eM!)'H: 9 j/b 4r,Ftt4'� 0 IJUS4gC- �) ,M„�,�f '� E�6y5�V 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the oonlents of fhb consignment are fully and accurately described above by the proper shipping name,and are dessified,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 eerti that the waste minimization statement Identified in 40 CFR 262.27(a)(If I am a large quantity generator)or a anbty generator)is true. era's Prinled Name Signet Ye p j 16. temational Shiprow ments ❑Import to U.S. Export from U.S. Port of eMrylexK: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials L Transporter i Printed/Typed Name Signature Month Day Year 3 �3 I H ran er 2 Printed�/T +Name Signa Month Day Year 18.Discrepancy I8a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Ahemale Facility(or Generator) U.S.EPA ID Number V Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a z N 19.Hazardous Waste Report Management Method Codes(,e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. � 3 20.Designated Facility Owner or Operator:Cedillcation of receipt of hazardous materials covered by the manifest except as noteJ In Item 18e Pdnled/Typed Name Month Day ear EPA Form 8700.22(Rev.12.1 Previous editions are obsolete. ESIGNATED FACILI TO EPA's e•MANIFEST SYSTEM