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DTSC. 02625 . 0827 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID NumberPage 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST t A U Q >-3-1 6 �� 2. 1 SIL, 311- 6-1 1012167144 JJK 5.Generator's Name and Mailing Address Generator's Site Address(if ddfereni than mailing address) Pc- w �r P� Le,,�. &Lh w Alv w Sb Generator's Phone: 'A 6.Transporter 1 Company Name U.S.EPA ID Number RAMOS ENVIRONMENTAL SERVICES CAD044003556 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address RAMOS ENVIRONMENTAL SERVICES U.S.EPA ID Number CAD044003556 1515 S. RIVER ROAD WEST SACRAMENTO,CA 9%91 916-371-5747: Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group('d any)) No. Type Quantity WtNol. 1. r- 3 c� OC � foo Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information A(� 9B1) ERGM71 . U 'g Clc) HANDLERS TO BE TRAINED AND USE APPROVED PPE. c E.R. CONTRACTOR: RAMOS ENVIRONMENTAL SERVICES 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labelediplacarded,and are in a.I1 respells in proper condition for transport according to appiicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,1 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity,generator)is true. Generatoes/Offeroes Printed/Typed Name Signature Month Day Year T PC C-e-"/ -j 1 16.International Shipments 1- ❑Import to U.S. El Export from IV Port of en Z Transporter signature(for exports only): Date leaving U.S.: CC W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Pnnted/ryped Name Signature Month Day Year ZZ Transporter 2 Prmted/Typed Name Signature Month Day Year H 18.Discrepancy �- 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facilitys Phone: w 18c.Signature of Ntemate Facility(or Generator) Month Day Year Q - Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintM Name Signature Month Day Year 0 3 EPA Form 700-22(Rev.3-05) Previous edKons are obsolete. - DESIANATED FACILITY T DESTINATION STATE (IF REQUIRED) 11624.0577