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i Please print cr type.(Form desgned for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 7 1.Generator ID Number Z Page 1 of 3.Emergency Response Phone 4.MarrlfM racki Number ,� � t c.� ---,�> c,''� # 1 (416j s71-57y7 ( 0 `� � "S9 JJK I WASTE MANIFEST :.flr- 5.Generators Name and.Melling A" r f l Generators She Address(if different than mailing address) 'P.. � / Generators Phone.'-yrD'i .- 1 .. It .x: L.e':.fti4.•. 6.Transporter 1 Company Name U.S.EPA ID Number RAMOS ENV1ROi MINT'AL SERVICES CAI) 044 ('03 556 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number VEOLIA ES TECUNICA.L SOLD IONS, LLC 2,1 :5 rt NSLEJ STREET, RICHMOND, CA 9.4801 Fa^M' sPhonle: (600)243-2382 CAI] 030 314 »79 9a 9b,U.S.DOT Descrip4on(including Proper Shipping Narra,Hazard Class.ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(I any)) No Type Quantity MNol. 13 Waste Cordes Z 2 LUO 3, 4 14r ,�1 Spedal Harding Instructions and Additional Information [. 7 , I Ill h i t r,1! Ll I' ( . HPI. •- f . 111 t , I 15, GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately desuibed above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemabonal and natioral governmental regulations.H export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste mlNmization statement identified In 40 CFR 262.27(x)(If I am a large quantity generator)or(b)(if I am a Trall gdantity,generator)is true. GeneratorsJORerors Prim tedlTyped Name Signature ': Month Day Year ...Jt 16.InwriatinalShipments I-. ❑Import to U.S. ❑Export from U.S. Port of entrylexit Z Transporter signature(for exports only): Date leaving U-S.: w 17.Transporter AcknoWedgment of Receipt of Materials Transporter 1 Print Vyped Name Signature Month Day Year O QTransporter 2 PrintedRyped Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑Ouentity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection ! Mandest Reference Number: 18b.Alternate Fac l,ty(or Generator) U.S EPA ID Number � t U [) ra+ Facility's Phone: w 18c.Signature of Altemate Facility(or Generator) Month Day Year z S2 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operalar Certification of receipt of hazardous materials covered by the man fest except as rnded In Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700.22(Rev.3.05) Previous editions are obsolete. GENERATOR'S INITIAL COPY I