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rnso-..Environmentol Protection Agencv <br /> ,ad OMB No 2050-0039 fExpires 9 30 99) See Instructions on back of page 6 Departimoi of Toxic Su isionces Contrai <br /> . <br /> At or type Form destgned far use on Ohre f f 2 orrcN rypewriser 5acramenro California <br /> UNIFORM HAZARDOUS ' <br /> Generator s US EPA ID No Mamresi Document No 2 Paget lntormarion in Me shaded areas <br /> i <br /> WASTE MANIFEST C AID 19 f 81213 14 0 14 1 2 4 oil 0 1 of s net required by Federal law <br /> 3 Generators Name and M.,long Address A- State ManillestDdulimse tNuaGiet �V'} R <br /> RUSS NELSON / NELSON READY MIX •- - _ 98'06,G.509 <br /> 9 <br /> 1040 MOFFAT BLVD. , RIPON, CA 95366 I B std:.Geteralors ID _ <br /> 1 I t Generotors Phone 1 f <br /> � 2091 982-5145 J! <br /> 5 Transporter I Company Nama 6 US EPA ID Number C. State TmtsspoinoWs ID _ <br /> r' RAMS NVI 0 NTAL S RVIC S � I A I D I 141410 10 I I I 16 D Traesporters Ph" <br /> 7 Transporter 2 Company Name (910 371-5741 <br /> 8 US EPA lD Numoer I I- State Transporters ID _ <br /> a 1 I 1 I 1 I 1 F Tronsporters Photons - <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number G_State Faeshty's ID - YSrTf y y - Jnr <br /> g RAMOS ENVIRONMENTAL SERVICES <br /> 1515 SOUTH RIVER ROAD, WEST SACRAMENTO, CA 95691 H_Faintly s Phots <br /> ICIAID101414101013151516 916 371-57-p— <br /> JI 1 US DOT Description lmcluamg Profiler Shipping Name Hazard Class and ID Numoer) I T2 Containers 13 Torm 1d Unit -- <br /> _ No type Quantity Wt/vol L Waste Nrim6ar 9i <br /> NON—RCRA HAZARDOUS WASTE LIQUID f <br /> 3r G {OILY WATER) NAERG96#171 /' I <br /> N b State 7— <br /> IE -- _-�,� --=k <br /> I r - <br /> =5 O <br /> Me I d <br /> . J. Add banal MPhone far Moterrafs Listed Above. - - s c -- - - - - K Handling Codes for Wastes, <br /> 26 <br /> 15 Saecsol Hondltng lnsrruciions pnd Aodihonal inrormahon <br /> al HANDLERS BE 40 HOUR OSHA/SARA TRA 7 <br /> AND USE NIOSH APPROVED PPE. <br /> EMERGENCY CONTACT: (916) 371-5747 <br /> —I <br /> C;I 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name ana are classified pacxea -I <br /> Jmarked and labeled and are in all respects m proper cond tion for transport by highway according to applicable international and national government regulations <br /> IF I am a large ouanhty generator k certify that t have a program in place to reduce the volume and toxicity of waste generated to the degree i have determined to be economtcolly <br /> procucable and that I have salecred the practicable-ler-od or t eat-neni rarage or aispesol Curren ly available to me wnvh minimizes rhe present and suture threat to Kumon health I <br /> and the environment OR ,F I am a small quantity generator I hove made a good faith effort to minimize my waste generation and select the oast waste management method that is <br /> available to me and that I con afford <br /> } Prrrsred/Typed Name S,g <br /> Rnor Month Day Year 1 <br /> u C C� OI7 <br /> w T 17 Transporter I Acknowledgement or Receipt of Materials <br /> ,{ Printed/TYpe�Name tnature <br /> N 9 no Da or <br /> sO ISI <br /> P 4-1 <br /> ,L 0 18 Transporter 2 Acknowle .�R.c.,o, I <br /> R Panned/T <br /> w E YPed Name Sig uta Monfft Day Year <br /> � R <br /> a <br /> V t9 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L <br /> 20 Faci3ily Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19 <br /> j Pr,nrod/Typed Name Signature <br /> Month Day Year <br /> I I � <br /> DO NOT WRITE BELOW THIS LINE <br /> DTSC 8022A (d/971 White TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> EPA 8700-22 To P 0 Box 3000 Sacramento CA 95812 <br />