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Please print or type.(Form designed for use on elite(12-pitch) ricer.) • Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CALOOM172 1 9163714747 1003359729 JJ K <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> KING ISLAND RESORT <br /> 11530 W: EIGHT MILE ROAD - <br /> STOCKTON,CA 95219 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES,INC. .. .. CA00440033 M <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Dei noted Facilit Name and Site Address U.S.EPA ID Number <br /> L�FEMICA- ASTE MANAGEMENT,INC. <br /> 35251 OLD SKYLINE ROAD CA1D008/5117 <br /> KETTLEMAN CITY,CA 93239 .. -. <br /> Facili 's Phone: 800`222-2954 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hal Class,ID Number, 10.Containers 11.Total 12.Unit <br /> and Packing Group if an)) 13.Waste Codes <br /> HM Y No. Type Quantity WI.Nol <br /> 1.. NON•RCRA HAZARDOUS WASTE SOLIDS (OILY SOLIDS) 352 <br /> 0 <br /> i Din <br /> z z. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Infornaton <br /> HANDLERS TO 13E TRAINED. SIO N _.. . Ell$171 <br /> 15, GENERATOR'SN)FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are clasai packaged, <br /> marked and labeledlplacarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Cone t. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(dl 9all qu thy generator)is We. <br /> GerneratVTOJImers Pnntedrryped NaSignature Mo D Year <br /> r r\ a <br /> J 16.International Shipments <br /> ElImportto U.S. ❑Export from U.S. P in I <br /> Transporter signature(for exports sell U.S.: <br /> w 17.TransporterAUmowledgment of Real of Metal <br /> Transporter 1 PrintedlTyped Name Signature Month Day Year <br /> 0 <br /> Transporter 2 Prin IIy-ped Name SignatureMonth Day Year <br /> 4. 18.Discrepancy <br /> 18a.Depepency Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial RejeNan ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Faciliry(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facilil Phone: <br /> w 1 S Signature of Alternate Facility(or Generator) Month Day Year <br /> zz <br /> ra19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and mcyding systems) <br /> 0 7. 2. 3. 4. <br /> 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the mentlest except as noted in Item 16a <br /> PrintedrTyped Nemo Signal Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous edtlionsare obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1 <br />