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`4 ese pnnt or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Ge erator ID N mtier 2.Page 1 of 3 mergenc Response Phone 4.Manifest Trac u el WASTE MANIFEST �'A�-O 'S�1�= p � 16+) *4 I.. 57,1*f �,.1 w P ` '" 1 '�d e.� JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) "mak 9rriz'llp�/ T4N�s �4?C Wk 0 CRANE SMACL 2420 EIGHT MILE RO. STOC . 3N,CA 95210 Generators Phone;., - 6.Transporter 1 Company Name U.S.EPA ID Number RAMOS E P,1IR0NMENvti.SLR'ICES INC. CAL1CraAai 15�i6 7.Transporter 2 Company Name U S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number R. Mi ENVIRONMENTAL &FRl4CE•, INC CAtx714fTt _i5 I5 5 SOUTH RIVER RD. VV ST':'A RA.IJENTO,CA 9%91 Facility's Phone:916-x,71.5747 ga 91b.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 Wt Nol. 1' NON RCCR/� R41ARDOI_l '.;,:. ;7i= SuLld (CAH.. DEk7i<,f::•} ;'.1 `Y5 33Z X2,5 O w Z 2. LU L ll � . 3. J N022 4. 14.Special Handling Instructions and Additional Info tion 9 El I)PR0FILE#RfsV-1161- 'J - GM 71 1 IANDLER;TO DI=TRAINED AAI USE APPRO�/ED PPE. E R CtJP1TFACTOR' RA,MOS E i 1RONMENTAL SFR,ACES X 15, GENERATOR'SIOFFEROR'S CERTIFICATIO : 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 re pests 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 cwnsiment conform to the terms of the allached EPA Acknowledgment of Consent. I certify,that the waste minimization statement i:nlified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am p sm II quantity generator)is true. G er for 0 erors tedlTyped Name S' n re o h ea f l c�c. _ rI t �- �1 J 16,International Shipments t— ❑Import to .S. ❑Export from U.S. Port of entry/exit z Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipl of Materia s ct: Transporter 1 Printed/Typed Namy Signature Month Day Year CL Z Transporter 2 Printed/Typed Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space 1 ❑ Q.antit Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q i Z C9 U) 19.Hazardous Waste Report Management Method Co es(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 01. 2. 20.Designated Facility Owner or Operator.Certificatio of receipt of hazardous materials covered by the manifest except s noted in Item 18a , Pdnted/Typed Name Signature f Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions arelobsolele. DESIGNATED FACILITY TO GENERATOR