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y <br />w i4? `Ku,ati r;; -., n—r Fnrm Annmvad_ (NMR Nn- 2050-0034 <br />EPA Form 8700-22( 3-05) PreWbuseftmaraobsolets. DESIGNATED FACILITY TO. GENERATOR <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. Manifest Trra�ckingNumber <br />Q <br />14 5 3 2 A <br />WASTE MANIFEST <br />CALW3395-3e6 <br />t <br />d11' -37t 55747 <br />U 1 ! <br />5. Generator efName artd Mailing Address Generators Site Address (if different than mailing address) <br />!, EICREtIECH RESOURCE RECOVEI?Y E)til6a,"t,6, A36 LLC <br />11626 itIOUSTRtAL OR. <br />STOCKTON, CA 952`19 <br />Generator's Pho r A <br />6 Transporter 1 Company Name U.S. EPA ID Numlbor <br />Rrhus ENMRONMENTAL SERVICES INC. C.POO.btt7fAT�5 <br />IF. Transporter 2 Company Name U.& EPA I?NWIW <br />B. Designated Facility Name and Site Address U,& EPA ID Nw her <br />RAMOS ENIVIR(INNIENTAL SERIACES INC. <br />15113 SC#JTH RIVER Ria. <br />WEST SA..CRAh1EN`T0, CA %691 <br />Fedlitys Phone,9i &&71-X47 <br />9e,. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />110. Cantalriers <br />1t. Totah <br />42 Unit <br />13 �tw ei <br />No. <br />TWO. <br />HM <br />and Packing Group (if any)) <br />Qu9mdly <br />iY6}lfol <br />S <br />1. NON R£t'4A I'W RDOLIS WASTE SOLID (OIL, DEBRIS). <br />GQf <br />Eikii ;, <br />f► . <br />-too <br />2. <br />W <br />119 <br />3. <br />14. Special Handling InstrudlonsandAdditicnal Information <br />�6 t)P1tL1EiLEif ER>i171� <br />E.R. C041R.ACTOf t Rt�1t� & EWRONMENTAL <br />I tkNO E?S SHOULD SE, TRAINED AND USE APPROVED. PPE' <br />15. 'GENERATOR'SIOFFEHOR'S CERTIEICATTON: I hereby, declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, ; <br />marked and labeled/placarded, and are in all respells in proper condition fortransport 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 EPAAcknowledgment of Consent. <br />Icertify that the waste, minimizatlon statement identified in 40 CFR 262.27(a) (if t am a large quantity generator) or (by (If I am a. srnall quantity generator) Is he. <br />Generatoes/Offeror's Printed/Typed Name Signature Month Day Year <br />165161- <br />1 <br />-j <br />16. Intematlonal SM menu . �-1 t " <br />❑ Import to U.S. QExpoitfrom U.S, `' of sntry/eltif. <br />Z <br />.Transportersignature (for exports only): 117 s <br />1% <br />Uj <br />17. Transporter Acknowledgment of Receipt of Materiels <br />'Trsnsporter4PilntedFf "am - - `- - : Sig t Mon#r . Di <br />CL <br />!r 11 <br />+ <br />T)A <br />GDil <br />X <br />Transporter 2 PrintedTyped Name i Month <br />Q <br />18, Discrepancy <br />''t <br />18a. Discrepancy Indication Space QUBnGIy IJ Residue 0 Pelyel fiefef4la►t LJ Ftll�R6'edfWY <br />Manifest Number. <br />18b. Alternate Facility (or Generator) U.S.EPAIDNwnber <br />LL <br />Faclutys Phone: <br />W <br />adlity (or Generator) <br />.180: Signature of Alternate F43 <br />RA9�1 <br />18. Hazardous Waste Report (Management Method 0ckIes tie codes br.t6zsrdous waste and recyclk systems) <br />a <br />20. Designated Fadlfty0wpefor Qpsrator: Certification of receipt of hazardous materials covered by the manifest except as n*d q Iteirtrt* <br />PrintedTyped Name Signature FAwth DY <br />e� <br />EPA Form 8700-22( 3-05) PreWbuseftmaraobsolets. DESIGNATED FACILITY TO. GENERATOR <br />