Laserfiche WebLink
Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.205 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CALM0191987 1 [116--371-57747 018141715 JJ M <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 38'S AUTO AND TRUCK PLAZA <br /> 14749 N THORNTON RD. <br /> LODI,CA 95242 <br /> Generator's Phonf n]9-649-7 425 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RAMO S ENVIRONMENTAL SERVICES INC. CAD044003556 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site AddressRAMOSENVIRONMENTAL SERVICES INC. U.S.EPA ID Number <br /> 1515 SOUTH RIVER RD. CAD044r-n-3556 <br /> WEST SACRAMENTO,CA 95691 <br /> Facility's Phonepl6-•371-5747 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1. NON RCRA HAZARDOUS 'WASTE SOLID (OIL, DEBRIS) P 352 <br /> Q0 <br /> W C> ri) <br /> z 2. <br /> w <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 9&1)PROFILE S-1019-15 ERG971 <br /> E.R. CONTRACTOR: RAMOS ENVIRONMENTAL <br /> HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate) described above ydhe proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationnational gov tal 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 EPA Acknowledgment of nsent. <br /> 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 amity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signatu Month Day <br /> A. <br /> .International Shipments <br /> E- ❑Import to U.S. ❑Export fmvvs Port of entry/exit: _ <br /> Z <br /> Transporter signature(for exports only): Date leaving U.S.; <br /> IX 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed f ature r, Month Day Y <br /> 0 SA1 "ice-- tL c <br /> Q Transporter 2 Printedlfy ed Nae Signature Month Day 1 <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection yP j El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> _J <br /> V <br /> tai Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1• 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Y <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIR <br />