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,vironmental Protection Agency <br />,No. 2050-0039 (Expires 9-30.99) See Instructions on back ge 6. Department of Toxic Substances Control <br />i. Form designed for use on effte f 12-pitch&riter. Sacramento, California <br />UNIFORM HAZARDOUS 1. Genergtor's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br />is not required by Federal law. <br />WASTE MANIFESTQ <br />�olego5�. 9 1 9 of <br />3. Generator's Name and Mailing Address �y,. i7 & rzt <br />.�w� �/J /gQ+1�fyy �j1 t �"�Tpw* t -j <br />rKVW si;ri+s�►t+o D� s�eicta��dA.9s3oh <br />A. Generator's Phone (— <br />5. Transporter I Company Name 6. US EPA ID Number Slgla*rtej up _y$a t <br />t iiti�ri) <br />IC <br />RAMOS RNMONMIENTAT. SERVICES 1A IT) lo 14 14 lo In 1-3 15 19 1c, F N <br />7. Transporter 2 Company Name 8. US EPA ID Number $ ¢� !• <br />9. Designated Facility Name and Site Address 10. US EPA ID Number W. Ila I rAm 94 <br />RAMOS ENVIRONMENTAL SERVICES <br />1515 SOUTH RIVER ROAD, WEST SACRAMENTO, CA 95691 <br />IC 1A ID 10 14 14 10 10 1315 �5 66.` <br />11. US DOT Description (including 12. Containers 13. Total 14. UnitProper Shipping Name, Hazard Class, and ID Number) No. Type Quantity Wt/Vol " <br />N <br />b. <br />E <br />R <br />A <br />T <br />C. <br />O <br />d. <br />,rr <br />15. Special Handling Instructions and Additional Information O Li <br />HANDLERS BE 40 HOUR OSHA/SARA TRAINED <br />AND USE NIOSH APPROVED PPE. <br />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 are classified, packed, <br />marked, and labeled, and are in all respects in proper condition For transport by highway according to applicable international and national government regulations. <br />If 1 am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyy <br />I hove disposal the future threat to human heolth <br />practicable and that selected the practicable method of treatment, storage, or currently avoilable o me which minimizes present and <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimiz y waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />If <br />Printed/Mg-e / / A,/- <br />Signatur <br />Month Day Year <br />T <br />17. Trans rter 1 Acknowled e�my[/ <br />enttoff Receipt of Materials <br />IRI <br />Pri ed/Typed Name ,i1 <br />Signature <br />Month Day Y <br />S <br />P <br />a <br />18. -Transporter 2 Acknowlad ement of ecei t of Materials <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (4/97) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />