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Please Print or type. (Form designed for use on ei'Its (12-nRchl tvnewriter ) <br />r - A ----A ^kin AI- -- <br />UNIFORM <br />mennoon <br />UEElLiNATED FACILITY TO DESTINATION STATE (IF IREQUIRIED) <br />UNIFORM HAZARDOUS <br />I-'30ner8l-r ID Number <br />2. 1 of <br />3. Emergerncy Respdrtse Phone <br />4. 1114111fest Trackin <br />WASTE MANIFEST <br />CAI <br />1 <br />009928032 <br />5. Generator's Name and Melling Address Generato's Site Address (If different than malling address) <br />QUICK .AND SAVE <br />1901 S. ELDORADO ST <br />Ze 9- 41,-- W J! 3 � STOCKTON, CA 9MOB <br />Phone, <br />Phos : <br />8. Transporter 1 Company Plame U.S. EPA ID Number <br />IWAOS ENVIRONMENTAL SERVICES CAD44dD03556 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Nara and Site Address U.S. EPA ID Number <br />RAMOS ENVIRONMENTAL SERVICES <br />1515 S. RIVER ROAD CAM4400M <br />WEST SACRAMENTO, CA 95691 <br />Faddi s Phdme: 916.371-5747 <br />ga. <br />9b. U.S. DOT Description (sutudiag Proper Shipping Name, Hazard Class, ID Number, <br />10. Conabd ers <br />11. Total <br />12. Unit <br />HM <br />and Paddrg Group (ff any)) <br />Ouan <br />Wt.Arct, <br />13. Waste Codes <br />No, <br />Type <br />NON RCRA HAZARDOUS WASTE LIQUID (OILY WATER I RINSATE) <br />a <br />2:3 <br />.. <br />0��V <br />z <br />LLI <br />2. <br />3. <br />4. <br />i <br />i <br />44. Special Handling Instructions and Additional Information <br />HANDLERS TO BE TRAINED. SIO 91)1) ERt'3'08#171 U.S.T. REM EA OIN CTION <br />�J . <br />15. GENERATOR'S(OFFEROWS CERTIFICA71ON: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packagers, <br />marked and labelediplacanded, and are In all respects in proper cxkndi8on for transport according to applicable international and national �vermrrental regulations. g export shipment and I am the Primary <br />Exporter, I car* that the contents of this rmn signmernt conform to One term of the adadred EPA of Conserv. <br />I certify that the waste rdnndzation statement Identified In 40 CFR 282.27(x) (ff 1 am a large quantity generator) or (b) (KI am a small quacntity gsneratorj is true. <br />Generatot's/99mr's N Name S~ Month Day Year <br />—r <br />1— <br />16.International Shipments <br />❑ Import to U.S. ❑ Expert from U.S. Pdrt <br />= <br />r>f enirytwdt <br />Transporter signature (for experts only): Date leaving U.S <br />13d17. <br />LLJO <br />Tmrsmder of Receipt of Materials <br />Ij <br />TranspdutePi PrknterUTyped fame Signature futorr0n Year <br />-Day <br />.,, <br />Trensporter2Printed(fyped Signature Month Day Year <br />18. Discrepancy • <br />18a. Discrepancy Indication Space <br />❑ Quantity ❑Type ❑ Reektue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Nwnber <br />18b. Alternate Facility {or Generator) <br />J <br />U.S. EPA ID Number <br />k <br />FaditysPhone: <br />rQy <br />ISo, Signature ofAllemateF�Nty-Genere" <br />Q <br />Month Day Year <br />19. Hazardous Waste Report Man8gamart McOM Codes (l.e., codes for hazardous waste treatment disposal, and recycling system) <br />1 . 2 3. 14. <br />20. Designated Facflly Owner or Operator. Cedittion of "t of hazardous materials covered by Ow rrwngest except as noted in Iters 18e <br />Printedffyperl Name - <br />Month Day Year <br />EPA Form 8700.22 (Rev. 3-051 Previous adttinn nnm <br />UEElLiNATED FACILITY TO DESTINATION STATE (IF IREQUIRIED) <br />