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RAMOS ENVIRONMENTAL ' 636 <br /> To Be Used For: NON-HAZARDOUS WASTES ONLY <br /> LENERATOR (GENERATOR MUST COMPLETE) WASTE TO BE DISPOSED <br /> N, .ME % TYPE <br /> FIE LD ADDRESS ` r /' e. GENERATING LOCATION <br /> Cl Y, STATE, ZIP < 1�. SPECIAL HANDLING INSTRUCTIONS <br /> DNE E – =GLOVES =GOGGLESOTHER <br /> ONATURE OF AUTHORIZED AGENT' QUANTITY %'— =BBLS./GLS. = YARDS =-TONS <br /> X DESIGNATED FACILITY <br /> NAME <br /> Di TE: . <br /> ADDRESS <br /> THE GENERATOR CERTIFIES THAT <br /> THE WASTE AS DESCRIBED CITY, STATE, ZIP <br /> IS 100° NON-HAZARDOUS <br /> PHONE <br /> I—TI ZANSPORTER (HAULER MUST COMPLETE) TICKET # UNIT NO. ' <br /> N,,ME i PICKUP DATE 2" " ' TIME <br /> _ ; DATE <br /> DRESS ' < f '' SIGNATURE <br /> N NOTE: THIS FORM TO BE IN LIEU OF THE CALIFORNIA <br /> DEPARTMENT OF HEALTH SERVICES HAZARDOUS WASTE <br /> PF SNE P.U.C. PERMIT NO. MANIFEST FOR NON-HAZARDOUS WASTES ONLY. <br /> AL FACILITY QUANTITY <br /> ISPOS <br /> Lc <br /> RECEIVED =BBLS./GLS. =YARDS =TONS <br /> N TIME AM PM <br /> Al -DRESS `� °" ' ` ` ` DISPOSAL METHOD: =SURFACE IMPOUNDMENT <br /> Cl Y, STATE, ZIP t ` = LANDFILL =INJECTION =OTHER <br /> PF ONE _ DISP. TICKET #J RETURN COPY TO: GENERATOR <br /> ATO NOT NECESSARY O SEND ISE SPECIFIED <br /> SI( Y'NATURF COPY TO DOHS <br /> D; EE REMARK$ <br />