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t _ <br /> Please print or type.(Form designed for use on elite(12-0tch)typewriter.) y Form Approved.0MR No,2050-0039 <br /> UNIFORM HAZARDOUS 11-GenwawlDNumber 2.Page 1 of 13.Emergency Response Phone 4.Manifest TraoldNumber <br /> WASTE MANIFEST CSS 1411 ��' 916 371-5747 00 0276879 JJ K <br /> 5. emtors Mance and Malting Add Generators Site Address(if different than marling address) <br /> *-�•� ate` oFs �ey lziEs S,`reD SAA 3" F"-r 0c44jyl3-z <br /> ` Srbe�Cfd�1.�. 4sao6cY, <br /> e.4. g53�i6 <br /> Generators Phone: O <br /> 0.Transporter 1 Company Name U.S:EPA ID Number <br /> RAMOS ENVIRONMENTAL SERVICES ICAD 044 003 556 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> /�/' i✓Psll�t� 3ivl�c,! MeW6941,zzl <br /> 1z <br /> 8.Designated Facility Name and SiteAddress U.S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS, LLC <br /> 1125 HENSLEY STREET, RICHMOND, CA 94801 <br /> Faci[ sPhone: (800) 20-2382 ICAT 080 014 079 <br /> 9a, 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unil 13.Waste Codes <br /> HM and Padding Group(if any)) No. Type Ouantily WLNd. <br /> `R0- wRs{-e <br /> LU <br /> 0 ` P <br /> 3,rjDa '� <br /> a'ao ccs c r3 C, <br /> L �-Oxr <br /> K Special Handling Instructions and Additional Information HANDLER TO BE TRAINED AND USE PPE. 5A0,V�-fall <br /> Bim-Ix 4AC-JAMI Ots, <br /> g3'rx sCVW_J D,.sa--0E;0 40090 - oa <br /> S. CENEkATOR'SIOFFEROR'S CERTIFICATION:I hereby declare thatthe contents of this consignment are fully and aoauratetp desarbed above by the proper shipping name,and are classified,packaged, <br /> marked and tabetedlplacarded.and are in all respects in properuondltion for transport according to applicable imamatmnal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAdmowledgment of Consent. <br /> I certify that the waste minimization statement ideatified In 40 CFR 26227(a)(if I am a large quantity generator)or(b)('dl am a small quantity generator)is we, <br /> Generators/Offerors Printedllyped Name Signa Month Day Year <br /> —4 16.International Shipments ❑ImpnM to U.S. ❑Export from U.S_ Port of entrylerdt <br /> Transporter signature(for exports only): Data leaving U.S.: <br /> W 17.TratnsportencclmoMedgment of Receipt of Materials <br /> re Transporter 1 Pdntad/fypWName rf� Signature Month Day Year <br /> loe I Co k)9Z Tre porter to yped Name Sig re Month Day Year l <br /> i0t; r ` 1,0V 191107 � <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑type ❑Residua ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Allemate Fauz7ity(or Generator) U.S.EPR ID Number <br /> v <br /> LL Facility's Phone: <br /> 18c.Signature afAltemale Facility(or f enaraW) Month Day Year f <br /> 19.Hazandou s Waste Report Management Method Codes(.a.,oodeJsfor hazardous waste treatment,disposal,and <br /> recycling systems) <br /> p J 1. / ' 2. f/ ! 3' 1 1#1 4' �ITJ <br /> 20.Designated Facility Owner or Operator.Certifiratlan off receipt of hazardous materials covered by Ore manifest except as noted In Item I% <br /> vrimewlypeo a Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10607.0322 <br />