Laserfiche WebLink
e.(Fowrdesigned for use on elite 12- itch)typefvdtec) Form Approved.OMB No.2050-0039 <br /> MHAZARDOUS 1.Generator ID Number f 2.Page l of 3.Emergency Respwse Phone .Manifest Tracking Number <br /> ASTE MANIFEST dqL-�—q-1q '�"�/ 1 (916) 371-5747 003615_238 JJK <br /> 5.Gema s Name¢gnil�MaTng Address --�— Genera Sim Address dd"eranl Na magi address) <br /> ( 4 <br /> 'i I jr�.ca;r3v)c �.�c> J� �6C.�•wi�.s:.fl4j <br /> I ,i,{ot9a G✓b+ TJ 51� ,{„sa)'Sf, G'.r$. <br /> Gensrelo s Phxte: al' � :Y3 3"�L.YJe� ,,1-,,,.� <br /> 6.Transporter me U.S.EPAIDNumber <br /> RAMOS ENVIRONMENTAL SERVICESCAD 044 003 556 <br /> 7.Transporter 2 Company Nemo U.S.EPAID Number <br /> S.Designated Facility Name and SileAddress U.S.EPAID Number <br /> RAMOS ENVIRONMENTAL SERVICES <br /> 1515 SOUTH RIVER ROAD, WEST SACRAMENTO, CA 95691 <br /> FacnitO Phone: (916) 371-5747 CAD 044 003 556 <br /> 94. 96.U.&DOTDescriiption(Indud'ng Proper SNpphg Name,Hazard Class,ID Number, lo.Cor inert ii.-nom 12.Unit 13.Waste Codes <br /> HAI and PecFdng GrwP(d anY)) No. Type Quantity SYtNoI, <br /> NON-RCRA HAZARDOUS WASTE LIQUID 223 <br /> (OILY WATER) <br /> ra0TT <br /> W 2 <br /> (e _ <br /> 3. <br /> 4. <br /> 14.Spedal Handling ImIructions end AddlWal InformaM ERC04#171 <br /> 9b1) <br /> HANDLERS TO BE TRAINED AND USE PPE, <br /> 16. GENERATOR'SIOFFEROR'9 CERTIFICATION: I hereby declare that the contents oflhls oorulgnment are tufty and accurately described above by the proper shippbg name,aril are classlf*d,packaged, <br /> marked and labaled/placerded,and are in at respeda In proper condition fa transport according to appicalste IntemalJonaland national governmental regulations.If export shipment and I am the Prarary <br /> Expoder,I artifythat the contents of this wnsgnmenl conform to the terms of the attached EPAAckwirecigment of Consent <br /> I anRy that the waste mmimtzatlon statement idenlred In 40 CFR 26227(a)(d I am a large RuenEly generator)a(o)(if l am a wall puanllry generator)Is true. <br /> Oenerelofs/ORerols Pdnledllyped Name Signature Month ay Year <br /> ratan N JGCL41xi,3 .0 7 cc l'/ 3 /01 68 <br /> 6.Intemotlonal Shipments <br /> ❑Import to U.S. Li F_zpori from U.S. Port oienby7axll <br /> . Transporter slignature(far exports only): .. . ........ .. ..... . . Dale laving U.S.: .. _ .. _. .. ....._. <br /> rrr� 17.TmnspoderAcknoWa%menlof Re VolMaleda's <br /> Trans r P 1 yped Neme ` Sgwlur bbnlh Day Year <br /> r'Fampoder Pdnled7Fyped Name \) Sig re IFw—Ih Day Year <br /> 4. 1BD6repancy <br /> fle.Discrepancy Indiction Spew ❑ Quantity ❑Type El Residue ❑Partial Rliectlon ❑Full ReecGon <br /> - Manllesl Referance Number. <br /> Hb.Alternate Fadfry(or Generator) U.S.EPA ID Number <br /> U <br /> a Igo.Sgnabire ofARemam Facriiry("Genrealar) I,fonlh Day Year <br /> 8 <br /> (U23 19,Hazardous Waste Report Management Mohnod Codea(is.,codes for hazardws vrasm treatment disposal.and recycgng systems) <br /> 0 1. 2. 3. 4. <br /> 20.Desgnafed Umar or Operator:Cedifiatiwofreceiptof hazardous materiels covered q' an4esl except as rd tam 188 g <br /> Printieffy1rad Nam 'nature M Va <br /> EPA Form 8700-22(Rev.3.05) Previous editlns am obsolete. DESIG A ACILI DESTIN9 STATE(IF REQUIRED) <br />