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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZA>7DOUS 1•Generator ID Number 2.Page 1 of3.Emergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST CA1 191987 1 16-371-5747 018141715 JJK 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 36S AUTO AND TRUCK PLAZA 14749 N THORNTON RD. LODI,CA 95242 Generator's Phon209.649-7425 6.Transporter 1 Company Name U.S.EPA ID Number RAMOS EM41RONMENTAL SERVICES INC. CAD044005-556 7.TransportEr 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site AddressRAMOSENMRONMENTAL SERVICES INC. U.S.EPA ID Number 1515 SOUTH RNVER RD. C.ADQ440? WEST SACRAMENTO,CA 95691 Facility's Phone.916-371-57477 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt./Vol. 1. NON RCRA HAZARDOUS WASTE SOLID (OIL, DEBRIS) P 352 0 Z 2. w 3. 4. 14.Special Handling Instructions and Additional Information X 9B-1)PROFILE ere'W/1?-15 ERG#171 E.R. CONTRACTOR: RAMOS ENVIRONMENTAL HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratel described above Hhe proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable internation national gov ail regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of nsent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)o )(if I am a sm antity generator)is true. Generator's/Offeror's Printed/Typed Name Signatu Month Day Year �u lntemational Shipments Z E]Import to U.S. ❑Export f� Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: UJ 17.Transporter Acknowledgment of Receipt of Materials O Transporter 1 Rdnted/Typed - .ature t Month Day Year Z Transporter 2 Printed/Ty ed Nae SignatureL� c f 4 Month (Day Year F- 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 ILL V Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z1 vs19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) p 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 Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)