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DTS�. 0034-5. 0586 <br /> Please pant or type.(Fano designed for use on elite(12yitU1)typewriter.) FpnnApproved.OMB No.20560079 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 d 3.Emergenq Response Plxane 4.Manifest The Number <br /> WASTE MANIFEST ..: CAUDOW91172 1.. .. 916371{747 0 0 3 numb" <br /> 7 2 9 JJK <br /> 5.Generators Name am Mailing Address Generaws Site Address til alaerent roan mailing address) <br /> KINGAMAND RESORT„ <br /> 11530 W.-EIGHT-MOP ROAD <br /> STOCKTON,CA 95219 . <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA 10 Number <br /> RAMOS ENVIRONMENTAL SERVICES.INC. <br /> 7.Transporter 2 Company Name w <br /> U.S.EPAID Numbs - , <br /> a.Desi paled Fadli Name and Site Address U.S.EPA ID Number <br /> -C MICPL. ASTE MANA.GEME TR H4C N . , <br /> - - -35251 OL O SKYLINE. _ . . . .. _., , •,•::• <br /> ROAD• ra••• ..`Y ... .� ,-...._. ++•s..-3n.nr,.a1:.,r.- CA70901SI61}7 '� <br /> KETTLBNW.CrrY.CA,93259, . .. .�s -. .. <br /> Facows.Phone:-900.22222VA .: . <br /> ga. I 9b.U.S.DOT Desorption Qndu ft Popper ShippiW9 Name,Hamel Class,IU Number, 10.Cp1lYinaa 11.TdM 12.NM <br /> HM and Packing Group(dany)) 13.WWW Coda <br /> No. type I 0-111i WUVd. <br /> z ..jll:�'«NOI*RCRA HAZARDOUS WASTE.SOLIDS.(OILY,SOLIDS) <br /> OvI - .�'.., .Y.cn.WL.. •+ti.4, v.M...ir. �. .352 <br /> 0 �... <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.$pedal Halling Instrucmns and Additional Ink Wn <br /> HANDLERS TO BE TRAINED:_. . ., ....,:Sro.1. .,y.✓_:.•M:,.:s,:._.1._;nERGTlts 173..�_..•�.. <br /> � 0 29°l3'012� f <br /> 15. GENERATOR'SIUFFEROR'S CERTIRCATION:I hereby ced ars put the contents of taus consignment are fully and acouratNy,described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in as respects in proper condition for transport a ou ing to applicable intemalumaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cendy that the comms ofthis consignment mnfotm to the terms of the atbdted EPAAcdtpMedgrtrem of Cont <br /> I certify that pre waste minimization statement identified In 40 CFR 26227(a)(if I am a large quantity generator)or(b)(itl e sn4 Witty generator)is true. <br /> Gernast s/0 hors Pnnmdz?-)pied Signature Month oav Year <br /> 16.International Shipments 1 <br /> ❑Impmlo US. ❑Eowlimm U.S. P n I t <br /> Transporter signature(for exports only): ,S: <br /> is, 17.TranspotanAckwa7edgmentofRemipl of Makimts <br /> yam. Transporter 1 Pninted?'encnzyped Name Sgnsture Monro Day Year <br /> 6 <br /> 2 Transporter 2"ru,dTlyped Name g <br /> Q 51gnature Month Day Year <br /> f5 <br /> i19.Dlsaepany <br /> 19a.Discrepancy Indleason Spam Query []Type ❑Fatima ❑Partial Rejamim ❑Full Rejection <br /> Manifest Reference Number <br /> 18D.Nieman,Fedliry to Generator) U.S.EPA ID Numbs <br /> J <br /> U <br /> IaL Fadlltys Phone: \ <br /> w lac.Signature ofNtemale Fadtity(cr Generator) Month Day Year <br /> Q <br /> Z <br /> ti19. ous Management Method Codes(La.,moss for hmrdws waste munment,disposal,and reeding systems) <br /> W 2. 3. 4, <br /> 1 DIg Fa ry or.Certification of receiplof Wzatdaus maturtzb covered the 1 as noted in Item 19a <br /> a / 111110citune <br /> EPAFoom 6700-22(Rv mvious ediddfs arepsolete. IGNATED FACILITY TO DESTINATION ST E(IF REQUIRED) <br /> 10225.1270 <br />