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SpleoiCaliiernia=Envie &otection.Agaocy-, <br /> fasm-kppteFBtI OMB No.2050-0 39(Expires 9-30-99h L See Instructions on back of a 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12.pikh)t, Sacramento,California <br /> UNIFORM HAZARDOUS 1. ..rotor's US EPA ID No. Manifest Document Na. 2.-Page 1 Information in the shaded ones <br /> is not required by Federal law. <br /> WASTE MANIFEST -A , of <br /> 3. Generator's Name and Mailing AddressEPIFL. Mate Manifest Document Number 23549491 <br /> GRA11_L: OPE:RA IIONS, INC.INS <br /> o t'.0 00X', 2 1-001,C.A. 952411 B. State Generator's ID <br /> 4. Generator's Phone( 209.334-7IXa7 <fn: JENNY VVId(iHi <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. Slate Transporter's ID]Reserved.] <br /> h <br /> + <br /> o �arrtasi m `elvis ^e D. Transporter's Phone <br /> 1 <br /> - <br /> o , 11116 - - <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporler's ID[Reserved] <br /> F. Transporter's Phone <br /> Q <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. St a 'in/ ID <br /> 3?d Ramos Environrnental Servil <br /> +*W1,515 .'1. River Rd. H. Facility's Phone <br /> G1 O W. Sacraatento, Ca. EY.pf l A A% q' 51 9"A 71-5141 <br /> Q 12. Containers 13. Total 14. Unit <br /> s J U 11. US DOT Description[including Proper Shipping Name,Hazard Class,and ID Numbed No. T—Type Quantity Wt/Vol I. Waste Number <br /> Z o. Stab <br /> 3 c Nan - RGRA IWarLiow Waste Liquid { 11111 Willi 0 /R EPA/Other <br /> o N b' State <br /> m E <br /> R EPA/Other <br /> A c. Stale <br /> o T <br /> m O <br /> R EPA/Other <br /> w d. Slate <br /> Z <br /> w EPA/Other <br /> U <br /> w <br /> � <br /> J. Additional Descriptions For Materials Listed Above K. Noodling Codea f r Wastes Listed Above <br /> O / ;IO Eo!}CCLK.TS �� CD)67 14412 c=` a. f L b. <br /> W <br /> d. <br /> Z <br /> I5. Special Handling Instructions and Additional Information <br /> Q W+1N1)I.-f=.R TOOFE TRAINED fAI.I, <br /> Z 244 Ifd E M[_R3EN+ r I:'OFdi:At l ij10 1 •,7d.; Int•# filt.i' <br /> F 2onn tN. RIF.PIEE2 f;G Li:'DI, . . 9 iI1:tJ i <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y described above by proper shipping name and are classified,packed, <br /> Vmarked,'and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nations government regulations. <br /> If 1 am a large quoNity generator,I certify that I have a program in place to reduce the volume and toxicity f waste generated to the degree I have determined to be economically <br /> a practicable and that hhove selected the practicable method Pry.. <br /> storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> d' available to me and that I con afford. <br /> O <br /> } Print d/Typed Name Signature Month Day Year <br /> Cil <br /> w T 17. Transporter 1 Acknowledgement of R cei t of Materials <br /> W R p PriggIed/Typed Na e �� Signature /p Month Day Year <br /> w s 11 e w e. I/ oil; o O <br /> 0 I e. Transporter 2 Acknowled ement of Recei t of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> w E <br /> N R <br /> U19. Discrepancy Indication Space <br /> Z F <br /> F <br /> C <br /> L l <br /> I 20. Foci Owner or O erator Certification of receipt of hazer .s materials covered b this manifest exce t nlnoted in Ite 19 <br /> Y Print'd/Type a `\ �'�.\ ,^= Signature '_-_ ""-{_\ +AQogIF'� �a� vYeaF <br /> i V /l J1 C I <br /> DO NOT WRITE BELOW TkS-LINE. ---- " d <br /> LIlow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS,- e <br /> DTSC 8022A(1199) produce <br /> who submil hazardous waste for transport out-oPstate, iB <br /> produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />