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ti <br />Please (I" ed fort on efte (1 2 -pi 'ter.) <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Pre, gete. DESIGNAT66ACILIT Y TO GENERATOR STATE (IF REQUIRED) <br />12150.0529 <br />UNIFOO US 1 1. GenerdfOr Number I 4 <br />-HX`ZM'= ID <br />7- ftge!of <br />3. ErnergelpResponse Phan <br />ImEK4Eg <br />4. Manifest Tracking Number <br />01472352.4 JJK <br />WASTE MMIFEST <br />7, <br />fs Name and MetingAddressi, Generators Site Address (dffmad than mailing address) <br />PRODUCTM. CHEMICAL INC. <br />-1011111 E. CMANNEL ST. <br />. STOCKTOAl. CA sm <br />Genef3t0fS Ph0nabn8LQAQ,?-J" <br />6. T Cwwy--0&iw-- <br />U.S. EPA ID Number <br />►RAMOS E�IIRONMEWAL SERVICES UX�+ <br />7. Transporter2 CompMy.N— <br />U.S. EPA ID Number <br />4'i fors -T <br />4 A ILI, v <br />�__D A-0 <br />& D " ted Facility Nam and Site Address <br />U.S. EPA ID Number <br />PACM RESOLIRCE PECOVERY <br />CAMIN112M�05 <br />315D EASY PILO BLVD. <br />LOS AWEILES, CA 2=3 <br />F=Ws Phone: OM,499-7145 <br />ga. <br />Sb. U.S. DOT Descroon (miudIng proper Shipping Nam, Hazard Clam ID Number, <br />10. Conghhrers <br />11. TOW <br />112. Unit <br />13. Waste Codes <br />NO. <br />Type <br />HM <br />and Paftg Gam' (d Cd - <br />ON=* <br />WLNOL <br />NON RCRA KAZARDOUS WASH UQUID (OLY SLUDGE) <br />Cal <br />DM <br />U3 <br />tu <br />LU <br />2. <br />10 U <br />4. <br />fo <br />14. Spa" ftmft Insbuctions and Additional Infonwition <br />901) RROFLEV t 4 1001)(0-1 ERG01711 <br />KANDLERS TO BE TRAINED ANDUSE APPROVED PPF_ <br />E.R. - CONTRACTOR RAMOS EMMMMENrAL s <br />IX5S <br />15. GENERATOWSK)FIFERDIrS CERTIFICATION. I hereby dedare that the contents of this cortsigoment are fi* and ac=Ady described above by the proper shipping name, and are classilied, padeged, <br />marikej and.labelediplacirded. and are In d respects in proper condition for transport according to applicable International and national governmental regulations. R export shipment and I am the PftM <br />Expmw, 1,oin* that the contents of this consignment conform to the terms of the attached EPA Adanowledgmant of Consent. <br />I w* that the waste mirtimbmilim statement IdentifieJ in 40 CFR 262.27(a) (d I am a large quantity generato_or (b) Cd I am a wW quantity generator) is true. <br />hofs PmhEedlTWhature <br />Month Day Year <br />r <br />1, 11. International Shipments El hW to U.S. EIExport fr04/ pmfentrykt <br />M <br />Tiransporter signature (far exports onfir): Date U.S.: <br />IX <br />Uj <br />17. TranspoderAdnowledgment of Receipt of Materials <br />Transporter 1 fttedffyped Nam A. Sif;lftature <br />Month - Day Year <br />CL <br />Ali <br />OF) <br />Transporter 2 Pr1rdedfTyped/7 000.� Signature <br />Month Day Year <br />Discrepancir <br />18a. Disaspancy indication Space 1:1 om*. 0Type. El Residd <br />Mantlast Reftrence Number <br />El Partial macti. <br />E]Ftm miection <br />18b.Aftemate Facifity (orGwerater) <br />U.S.- EPA ID Number <br />L& <br />FwWs phone: <br />W <br />18e. Signature ofAllemate Facility (or <br />Morutr Day Year <br />19. Hazardouss Waste Report Management Method Codes (ie.. codes W hazardous wage treatment, CU. -Pout and recyC%V systems) <br />1.2. <br />H <br />06-1 <br />4. <br />20 Designated Facility Owner or Operator: Calkstof receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br />PrifftediTyped.finw— Signature <br />Month Year <br />711)1/51 <br />EPA Form 8700-22 (Rev. 3-05) Pre, gete. DESIGNAT66ACILIT Y TO GENERATOR STATE (IF REQUIRED) <br />12150.0529 <br />