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Slate of California—Erwirbnmestal Protection Agency k O back C
<br />See Instructions an
<br />Form Approved OWS No. 2050-0039 (Expires 9.30-99) fl. Department of Toxic Substances Conti
<br />'Please print or typ6' Form designed for use on elite (I2 -pitch) typewriter. Sacrament, California
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<br />Ycilow TSDF SENDS Ili'S (()PI I-. (,ENERATI)n V11,111A iU I'A,
<br />DTSC 8022A (1/99) (Generote s -w-u I- ,,m !:,, —,rrr 1;, ,.w,n r1 • ,t a
<br />EPA 8700--22 pwdvice :n- p ",(s . ,1„ ,f 'his "'I'v un.i . • .:i
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<br />UNIFORM HAZARDOUS
<br />1 Generator's US EPA ID No. Manifest Document No
<br />2 PagI
<br />rmation in the shaded oreos
<br />WASTE MANIFEST
<br />C A n 9 8 1 9 6 4 4 8 9 6 1 1 1 ; ? J.
<br />of
<br />ot required by Federal law,
<br />3. Generator's Name and Mailing AddressMAR 0 8 2004
<br />DART CONTAINER
<br />A. Stole Manifest Document Number 1
<br />1400 E. VICTOR ROAD, LGDT, CA 95240
<br />6. SlaleGenerator'sID
<br />4. Generator's Phone (209 ) 333-8088
<br />5. Transporter I Company Nome 6. US EPA ID Number
<br />C. Stole Tronsporler's ID [Reserved.]
<br />RAMOS RNVIRONMENTAL SERVICES IC JA ID 10 14 14 10 10 13 15 15 16
<br />D Transporter's Phone (916) 371-5747
<br />7. Transporter 2 Company Name 8. US EPA ID Number
<br />E. State Transporter's ID [Reserved.]
<br />F. Transporter's Phone
<br />9. �sjppatsd�,gsili Nc�g d $jtp(ddress 10. US EPA ID Number
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<br />G. St a j^( D 4117
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<br />3�/65�0�EtlYYA11S'T 26TI4 STREET, VERNON, CA 90023
<br />H. Facility's Phone
<br />I (A IT 10 13 0 0 3 1316 8 1
<br />(323) 268-5056
<br />11. US OOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
<br />12. Containers
<br />13. Total
<br />Quantity
<br />14. Unit
<br />Wt/Vol
<br />I. Waste Number
<br />No,
<br />Type
<br />a NON-PCRA HALARDOi S WASTE SOLID
<br />Stole 352
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<br />E
<br />(oily soli_dF.') ERG '00 #171
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<br />EPA/Other N/A
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<br />EPA/Other
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<br />State
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<br />EPA/Other
<br />d.
<br />State
<br />EPA/Other
<br />Additional Dekripti for Materials Listed Above
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<br />11a,
<br />K Handling Codes for Wastes
<br />Lisled Above
<br />-JI GT tdP{SVG
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<br />6.
<br />S"�L '21�'1Y Js ID5-ir1Z
<br />15. Special Handling Instructions and Additional Information
<br />HANDLERS TO BE 'CP,AINED AND USE PPE.
<br />24HR EMERGENCY CONTACT: 916-371--5747
<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 ore classified, packed,
<br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notionni government regulations,
<br />If I am a large quanliy generator, 1 certify that I have a program in place to reduce the volume'and toxicity of woste generated to the degree I have determined to be economically
<br />practicable and that I bove selected the practicable method of treatment, storage, or dispos randy available to me which minimizes the presenf and Future threat to human health
<br />and the environment OR, d i om a small quantity generator, I have mode o good faith a oil minimize my waste generation and select the best waste management method that is
<br />available to me and that I can afford
<br />Printed/Typed e r
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<br />Slgnaru��
<br />Month Da Year
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<br />17. Transporter I A<knovACd t of Recei t of Moterials
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<br />Printed/Typed N si
<br />Signature
<br />Month) Day/- Year
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<br />18trans oiler 2 Acknowled ement of Receipt of Materials
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<br />Printed/Typed Name Signore OK E Vit ONMENTAL FACILITY IN LOS Month bay Year
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<br />19. Discrepancy Indication Space
<br />APPROPRIATE PERMITS TO RECEIVE YOUR
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<br />WASTE STREAM AS QUALIFIED OUR EPA
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<br />20. Foci or Operate, erfi4icotion o cel t of hazardous materials covered b this anlfest ce t os noted in Item 19�
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<br />Signature _ _ - --�` - - /�N]ostk\ ,Day` ,� r
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<br />DO NOT WRITE BELOW THIS LINE.
<br />Ycilow TSDF SENDS Ili'S (()PI I-. (,ENERATI)n V11,111A iU I'A,
<br />DTSC 8022A (1/99) (Generote s -w-u I- ,,m !:,, —,rrr 1;, ,.w,n r1 • ,t a
<br />EPA 8700--22 pwdvice :n- p ",(s . ,1„ ,f 'his "'I'v un.i . • .:i
<br />90-d 8££L £££ 60Z I U3NIVLN03 LUVO tf0£ = LO 'b0-91--A'eW
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