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Please print or type. <br /> UNIFORM E♦AZARDOUS t.GeneratorlD Number Form Approved. 0M8 No. 2050-0039 <br /> 2. Page 101 3. Emergency Response Phona 4. Manifest Tracking Numbar <br /> WASTE MANIFEST CAUM48M 916.3715747 019912242 JJK <br /> 5. Generators Name and ;aging Address <br /> COUNTY OF SAN JOAQUIN PARKS Generators S1eAddress ( f ditereet Than marling address) <br /> 11793 N MICKE GROVE RD, <br /> LODI, CA 95240 <br /> Generator's Ptwna2w1&953 7030 <br /> 6. Transporter 1 Con pany Name <br /> RAMOS ENVIRONMENTAL SERVICES INC. U.S. EPA ID Num mr <br /> 7. Transporter CcrI Name CA00441 <br /> G , 1� ' U.S. EPA ID Number <br /> 8. Designated Fad€by NarremdshAddressPACIFICRESOURCERECOVERY U. 0EPA I111 ll� � � � � � <br /> S. D Number <br /> 3150 EAST PICO BLVD. CADODB?82l0$ <br /> LOS ANGELES, CA 9=3 <br /> Facility's Phone:8OD44997145 <br /> 9a, 9b U.S. DOT Desatptlon Qnctuding Proper Shaping Nam,III, Hazard Class, ID Number, <br /> HM and Packing Group (ifany)j 10. Containers 11. Total 12. Unit <br /> x <br /> 1. UN1325, WASTE FLAMMABLE SOLID ORGANIC, NOS, 4.1 , PGIII No. Type Quantity WtNoi. 13* ftteCodes <br /> `� (GASOLINE, DEBRIS) '�" P 352 EMI 0018 <br /> ul <br /> 3. <br /> 41 C <br /> 14, Speciiiiiiiiiiiii ME <br /> al Handling (nsbuctions andAdd4iOnal l lemma6on <br /> 984)PROFILE <br /> E,R , ER{i�ifl33 �C1512d� <br /> CONTRACTOR: RAMOS ENVIRONMENTAL <br /> HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE t' )e 57' <br /> 15. GENERATOR'SIOFFEROR ;EFMFICATIOU: I herebydectere that the contents of this WpunlnwK am naly one accuramy described above OY I me propersupping name, ard am dassified, packaged, <br /> marked and labOe4lacanied, and are in an respects in proper condmtion for transport according to applicable intema0onalard national governmental <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAdm regulations. if export slm�nrment and i am the Pr nary <br /> cergty Mat the Kzsta n nimization statement identified in 40 CFR 26227 a rf i am a la owiedgmenl o/Conseni. <br /> GeneraWslOfferoesPdnt OC large (It anitygene2tor) Islrue. <br /> e nature <br /> Abnlh Day Year <br /> 16. inlema5onai Shipments ~ <br /> Import to U.S. <br /> Transporter signature (forexpatsonty): ornU•S• ` Pod ofentrylexit: <br /> w 17. Transpoder ent of R Dale leaving U.S.: <br /> AcknotiN,edgm ocetptofMated�s <br /> Transporter 1 Printed No <br /> y, Slgnatur i Menu, <br /> Day Year <br /> ZZ Transportar2Ptinled/Typed Name _ Signature <br /> Month Day Year <br /> ~ <br /> 18. Discrepancy <br /> 18a.Oisaepa( cy Indication Space <br /> ❑ Quantity ❑ Type ❑ Residue ❑ Padiall'i*ction ❑ Foo Rgection <br /> 18b. Alternate Faa'Gty (or Ganerator) Mardrest Reference Number. <br /> U.S. EPA a0 NumbeC <br /> V <br /> FaciliVs phone: <br /> F18c. SignatureofAllemat. F13aTmty (orGeneralor) WON III will I <br /> Q Ambo h okay Year <br /> Z <br /> 19. ttazatEous tNasta Report Management Method Corks Cr e. miles forhaza(dous waste trealaw <br /> 0 1 2 tsposal, and recyc6rng systems) <br /> • e € <br /> 20. Designated Facilty 0•vnnaror Operator Certificatan M <br /> re*PdntedlfypedName tot hazardous materials covered bythemanffeslencepf nctedkrlleml8a I <br /> Signature Month D Year <br /> EPA Form 8700.22 (Rev. 11117) Previous edtio s are bsolete. I ! <br /> DESIGNATED FACILITY TO EPA's L-MA (FEST SYSTEM 1 <br /> E <br /> 1 <br /> I <br />