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nTcr C117A0 1 1; C� <br />V t J V• V J I R 1 1 V j <br />d.' C 1P ♦,. -,:i Cali , : !,I : + ♦' /11tii11 <br />Foran Approved. OMB No. 2050.0039 <br />EPAFotm 8700.22 (Rev. 305) Previous editions are obsolete. DES16NATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />12288.1517 <br />UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3 Erne envy Reponse Phare 4. Manifest Traddng Number <br />WASTE MANIFEST a� ti i tq«� 3 �'-s``1 015855421 JJ K <br />era s SifeWddlass Cd dNferent than meifiag address) <br />5. Generator's Name and Melfi g Address KPr ; l.00 C40 <br />IAI AI/A <br />11300 E• CHANNEL ST• <br />31 STOCKTON. CA 95205 <br />GereratorsPt le <br />8. Tmnsportor 1 e U.S. EPA ID Number <br />RAMOS ENVIRONMENTAL SERVICES INC <br />1. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />RAMOS ENVIRONMENTAL SERVICES INC. <br />1515 SOUTH RIVER RD. CAD044003556 <br />WEST SACRAMENTO. CA 95691 <br />Fad6tys Phone: 916.371-6747 <br />ga, <br />9b. U.S. DOT Description (including Proper Shipping Name. Hazard (lass, ID Number, <br />10. Contaerare <br />11. Toth <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Paddng Group (if any)) <br />Quantity <br />WtNoi. <br />® <br />1. NON RCRA HAZARDOUS WASTE LIQUID (OILY SLUDGE) <br />001 <br />DM <br />G <br />343 <br />z <br />2. <br />W <br />69 <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />9B-1)PROFILE j1® ERG#I71 adv.4MS !� { <br />E.R. CONTRACTOR: RAMOS ENVIRONMENTAL <br />HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE <br />15. GENERATOR'S(OFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fury and accurately described above by the proper shipping name, ard are classified, padm*, <br />marked and labeled/placarded, and are In all respects in proper condition for transport according to applicable international and national governmental regulations, If export shipment and I am the Primary <br />Exporter, I oe* that the contents of this corisignment conform to the toms of the attached EPA AdmovOedgment of Consent <br />I certify that thewaste minimization statement entified In 40 CFR 262.27(x) (if I am a large quantity generator) or (b) Cd I am a small quantity generate Is true. <br />�j ^ DayGenera v�e� \r <br />a Nam Signs Month/ di6 <br />-j <br />16. International Shipments ❑ Import to U.S. ❑ Export;;, U.S. Port of an;;;; <br />Transporter signature (for exports only): Date leaving U.S.: <br />w <br />17. Transporter Admwledgment of Receipt of Materials <br />p� <br />d <br />Trans iter 1 PdntedlT Nance u Day Year <br />"'Q.! 441 3 <br />Transporter 2 Prin yped Name Signature I Month Day Yeir <br />18. Discrepancy <br />186. Discrepancy Indication Space ❑ Quantity ❑Type ❑ Residue ❑ Partial ❑Fut! ReJedbn <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />V <br />Faalitys Phone: <br />W <br />18c Signature of Allemate Facility (or Generator) <br />Month Day Year <br />Q <br />ED19. <br />Waste Report t Method Codes (i.e., codes for waste disposal, and reciding �fm) <br />1.1Iq <br />2 <br />3. <br />4. <br />20. Designated Facility OwnerorOperator: Certification ofreceiptofhazardous mawrwswvemdbyft malt except as rented In Item 18a <br />l <br />Prifileff-"ypped"Nana Sgnstute Month <br />�..•.--I V 6( J <br />EPAFotm 8700.22 (Rev. 305) Previous editions are obsolete. DES16NATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />12288.1517 <br />