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Peaseprint or We.(Form designed for use on elila(12-p'.c.)typewriter.) Form Approved,DMB No.205G4039 <br /> UNIFORM HAZARDOUS 1.Generator ID kumher Z Page:�;= <br /> e Phone 4.Manifest Trac Ing Number <br /> WASTE MANIFEST C A�ago yg .' 10171 4 5 6 2 5 JJK <br /> 5.Generator's Name and Ma&gAddreys (Ef different than mallirg address) <br /> ,Gv:b► 2)L4e - 40-D i GtSD-LoDr ht7113'//.56W-Cl _ <br /> Lv.D,•, cA. 9s-z -tel s r mrd 1v . 9 <br /> Gonerator's Phone <br /> B.Transporter 1 Company Name U.S.EPA ID Number <br /> RAMOS ENVIROWAEMAL SERVICES ZC, CA0044003M <br /> 7.Transparler 2 Company Nana U.S.EPA ID N umber <br /> a.Designated FariI4 Name and Site Address U.S.EPA ID N umber <br /> V'EOLA ES TEW AL SOLUTIENdS CAT= 4M <br /> 1125 HENSLEY SfRMT <br /> RICHMIOIRC),CA 9841 <br /> Farafitys PhonODD-243-2382 <br /> ga. 9b.U.S.DOT Description(including Proper Sho-g Name,Hazard Class,ID Number, 10.Containers 11,Total 12,Unit <br /> I:M and Paddng Group(ifany)) No. Type Quantity WMI. 13.Waste Codes <br /> a 1.urJ-1,39,(Ar1�5�€O 9 :rJ4 <br /> LU <br /> 10 � <br /> Lt Z I=pv,c c] l 1 Cf]� 1+�'J ,rJ.0.5.J <br /> 4'sk01943, WAS+ rI -F Lz — -3.a S.,3 <br /> 114,Special HanWg Instructions and Additional lnloambon <br /> HANDLERS 90-U 13E'CRAZED AND USE APPROVED PPE '°1•� f X 5 S G� <br /> 96 98 ) Zitss�- PL>�-s1) yE <br /> 15, GENERATOW&OFFEROR'S CERTIFICATION:I hereby declare that the contents of this owsignmant are Tully end&==Wy descrM above by the proper ehlpgN name,and are clawifled,paciagad, <br /> marked and labeledrptaralded,and are In aH respects in pmper cundi4an fortransport according to applicable Intemationaiand riattonal govemawU regulabow,If export shipment and I am the Primary <br /> Exporter,I cerbty that the contents of title consignment conform bathe terms of the aty%ed EPAAclumWedgmant of Consent. <br /> t certify that the waste minimtxathn eatenmi Identified In 40 CFR 26237(a)(d I am a Large quantity generator)or(b) m a small generator)Is truce. <br /> Generao .� OYear Pge <br /> 16.Intematlanal Shipments11 <br /> Import to U.S. ❑Export Pram U.S. Part of enbyle* <br /> Transporter signature(for azparts only): Date leaving U S.- <br /> 17 TramporterAd=wledgnrerd of Receipt of Materials ' <br /> QTransporter 1 Printad(Typad Name S gnatu Month Day Year <br /> CL I 38i <br /> Transporter 2 Pmta(gyped Name SkjnatA Month Day Year <br /> 18.Discrepancy <br /> 18a,Cisaeganry Indlgllon Space ❑ Cuantity ❑type ❑Residue ❑Parfiai RaJecfian [:]Ful Rejection <br /> Manlfeal Reference Number. <br /> 18b.Altemats FaciiRy(or Generator) U.S.FPA IO Number <br /> U <br /> racili"Phone: <br /> LLj l ilt~Signature clAlternate Fadty(or Generator) Month Day Year <br /> d <br /> y19.Hazardous Waste Repott Management Method Codes¢.e.,codes far hazardous waste 8ea4nerd,disposal,and rung systems) <br /> T. <br /> 4. <br /> 24.Designated FacdEty Owner or Operator Cart=don of receipt of h=rdaw materials covered by the manifest except as Med In Item 19a <br /> Prin"Typed Name Sfgtawra Month ay Year <br /> FPA Form 8700.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILIIYTO DESTINATION STATE(IF REQUIRED) <br />