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Please print or typo.(Form designee{for use on el)te(12."pitch)(ypowrllor.) Form Approver(,00 No.2050.0039 <br /> UNIFORPA HAZARDOUS i GarlarafoffD Numb0r 2.Pago 1 of 3.Emergency Rowans:Phone 4,M(ea'i�lfast Trraarkkii�ng Number /� r} i <br /> WASTE f ANIFEST CALW0779992 i 916,371.5747 11 �J.1 7 r{L, g,q <br /> 5-Genamlor>Hama and Maling Address Generator's Site Address(if different II)m malalg address) <br /> V ndminds and Sons cl• <br /> t�s.sacramesT:o st. <br /> Lodl,CA 95240 <br /> Generoior's Phcnu: �. �� <br /> 6,Transparlcr 1 Compeny Nam6 US.EPA ID Numher r <br /> r. <br /> RAfivf6S ENV1f�tahihrlEhfT'AL SERVICES CAi3D44i�?3�„55 �. <br /> 7.Tmm orator 2 Company Name U.S.EPA ID Nurnbar ' <br /> UJOW Nanta and Silokddrase U.S.EPA ID Number <br /> FOLIA ES TECHNICAL SOLUTIONS, LLC CAT0t3t�J14078 <br /> 1125 HENSLEY STREET <br /> RICHMOND,CA 94Wi <br /> Fe0ity's Phona: t3 1�d3 2 <br /> gn 9b.U.S.DOT D9cepimn(indading Proper Sir:ppfng Nante,Ha7Afd C'a; ID Nu bee 16.Containers_ 11.Tolal 12.Unit " <br /> H61 and Parkfig Group(if an-1)) _ No. Type Quanfity VA Not, <br /> 13.Wmlo Collas <br /> 1 WASTE ENMRONb1ENTALY HA'AADOUS SUBSTANCES SOLID, NOS, O)i DN � SBi =70 9,UN 2,POIII(SEAR BLAST) e _.. ...... <br /> 2. <br /> A � _..._........._ <br /> 3. <br /> DEC L 2uiJ ; <br /> WrW-r+u rlr--nA0"rRAr-N1"i <br /> 14.Special Hanrtu17ln5WclonS andAdditional Iniermalian '` <br /> 38-1)PROFILE#105,337 ER(:t71 � r�IS <br /> E.R, CONTRACTOR: RAMOS ENVIRONNIENTAL <br /> HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE ��� �),3 Ut <br /> 15 GENERATOR'SIOFFEROR'S CERTiFICAiIOH:I hereby decfaro that the eantenla of this conetgnmunt aro fully and acw atolydasaibed aUove by tl,e proper shipping name,and are clmAad,padigod, <br /> marked and laboted;piacardad,and aro in a!t respects in proper crnrdilion for transport according to appLcaGta IntnmaGon land notional gavommentei reguln6'ons.If export shipmant and I am Ifro Prfmsry <br /> Exporter,t cwI!fy!bal(ha conlor.is rax Oua wnalgomont conforn to Via tame of the allached EPAAcxnmwlc tgrnant of Consaol. <br /> cedffy(qat the vrasle minlmization statement klanf Red In 40 CFR 26227(a)(if t am a large,Guart;ty gona;atar)or(b)(if l am it smaf!quantity ganarofor)fs(ue. <br /> Grr ntoi's10!feror'c PdntoaITypod Name Sl g i V ro I"mith Day Year <br /> tz <br /> r 16.IntoinationalGt!ipmsnta ILI <br /> ❑In:p t to U.S. ❑ <br /> Export from U.S, Port of <br /> Transporter s"Onaiuro(ter exports only); Dale leaving U.S: <br /> a U.irc sfo;terAcknowedgrnmitofRoce!plolPdalo ars <br /> ry <br /> Tr s on,1 PdnladlTypad Noma S;gnature f ) Plc!h Da Year <br /> 1A <br /> z rl'm•valor 2 Pint d(Typod Hamo JF Sign gyro I,far1) Day Year s <br /> � <br /> its.Di=_crepancy <br /> 1&DiscrepancylndkaticnSpace ({ l < <br /> ❑ Quantity !_�Typa ❑Residua ❑PaniMRejection ❑ t,1Rejerion <br /> i.. <br /> hien-(Refmroct Number: <br /> 18b.Fdtenra!v rablity(cr Generator) U.S.EPA ID Number <br /> 1 <br /> � i. <br /> w Facfly's Phone: <br /> w 18c.Signature of Almelo Facility(or Generator) Month Cay Year <br /> S <br /> z _ <br /> 19,Hazardous Vi8slo ReportAianogement McilnA Codas(i.e.,cedes for hazardous waslo haalmanl,disposal,and racyr3iny systomsj <br /> 3. A. <br /> 20,Dostgnated FapYity Owncror Operator.Cert rra6on of racufplofhazsNous materials covered by themarri(ast oxcept as nciadin Rem 18a <br /> Pnntedit'ypedNama Signature Mon. Day .Year <br /> A f/V1 _ 2!1 )2— <br /> EPA <br /> 2—EPA Forn18700-22(Rev.3.05) Previous editions aro obsoleto, DESIGNATED FACU'rY TU DESTINATION STATE(IF REQUIRED) <br />