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State oFCalifornia—EnviranmeNal Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) <br />pleomP rint or yes Form designed for use on elite II 2 -pitch) "a <br />�a <br />%J <br />DC <br />J <br />2 <br />4 <br />3 <br />C <br />a <br />a <br />c <br />C <br />a <br />C <br />t <br />u <br />l <br />v <br />See Instructions on back of pa'-- 6. Department of Toxic Substances Control <br />Sacramento, California <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A 11/99) Yellow: GENERATOR RETAINS <br />EPA 870D-22 <br />I. Generator's US EPA ID No. Manifest Dxumant No. <br />2. Page 1 <br />Infora Ilse shaded or., <br />isnot regatred by Federal law. <br />isnot required <br />UNIFORM HAZARDOUS <br />� � 7 <br />WASTE MANIFEST <br />Z 4 <br />aft <br />3. Generator's Name and Mailing Address -'A :f< ri'l} <br />A. Slate Manifest Document Number 22827433 <br />/7/ys AlDeiRi'2-5R� <br />B. State Generator's ID <br />(� ?Y-2 t/t <br />A. Generator's Phone ( 7 x`7) I ?(sl v��•Q <br />5. Transporter 1 Company Nome 6. UB EPA ID Number <br />C. Store Transporter's ID [Res_rved.] <br />D. Transporrer's Phone <br />4 <br />ASBURY ENVIRONMENTAL SERVICES C A p 0 2 p '7 7 0 3 eb <br />Z Transporter 2 Company Name B. US EPA ID Number <br />E. slate Transporter s ID [Reserved.] <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Sbre faciliyb ID <br />RAMOS ENVIRONMENTAL <br />H. Facility's Phone <br />1515 SOUTH RIVER ROAD <br />96091 'A L) U 9 4 0 0 -3 S 6 <br />CA <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Contolners <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />1. Waste Number <br />No. <br />T pe <br />stare <br />NON -RCRA HAZARDOUS WASTE, LIQUID (WATER, OIL)U <br />223 <br />EPA/Other <br />G <br />*NO PLACARDS REQUIRED' <br />T, <br />` I <br />E <br />6 <br />Stela <br />N <br />EPA/Other <br />E <br />r R <br />r A <br />Stare <br />T <br />EPA/Other <br />i O <br />R <br />i <br />d. <br />slate <br />j <br />EPA/Other <br />1 <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />WATER_q,F7- 6 0 <br />a. <br />6. <br />a. <br />d. <br />i <br />15. Special Handling Instructions and Additional Information Y TV 1j e S j <br />USE f IDE URGENCY CONTACT :GHEMTRE.0 1-OM424-9jW <br />'vX <br />NAERG#:11A. 171 <br />�_ <br />16Sy3Ailo5 GsyE `j3 6 � f'" <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />for transport by highway according to applicable international and national government regulations. <br />marked, and labeled, and are in all respects in proper condition <br />L <br />If I am a large quantityavgenerator, 1 certify that I hove a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />I he the of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />D <br />practicable and that selected practicable method <br />and the environment; OR, if I am a smaquantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />r <br />available to me and that l can afford. <br />Printed/Typed Name <br />Signatur� <br />Month ay( Ywr <br />1/,D7 <br />T <br />17. Trons rler 1 Ack ledgement of Receipt of Materials <br />j._Printed/Typed <br />L <br />Name .� �. _.-„�, Signature <br />P r- <br />Month Day Year <br />0 <br />. <br />Trans rter 2 Acknowled ement of Receipt of Materials <br />.Transporter <br />D <br />T Printed/Typed Nome Signature Month Day year <br />ss <br />Q <br />E <br />R <br />J <br />19. Discrepancy Indication Space <br />Z <br />— <br />F <br />A <br />C <br />I <br />L <br />1 20. facili Owner or Operator Certification orecel t of hazardous maroria6 <br />covethis monilast axce t m noted in Item 19. <br />red by <br />T Printed/Typed Name <br />Signalure <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A 11/99) Yellow: GENERATOR RETAINS <br />EPA 870D-22 <br />