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d r <br /> Please kfint or{ (Form designed for use on elite{12 MxWdE � =_ + Form Approved.01013 No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.i=meigency Response Phone 4. 1anHeATracking Nu <br /> WASTE MANIFEST CAD98A0yA3y3 � a � _ 017145641 JJK <br /> 5.Generators and Malling Address f _• J Geri Site Address(d different than malling address) <br /> .L 010 UA/r F,'E0 SCP=L ,>,5bV_ C T ,CO'b"ccs 0 Te>Awy &!;H -5C l aaL <br /> //// W'ef C 6M4, .41 &11d <br /> eA <br /> neerramr Ps P hcoe:' Qy l- /y 5 4 T7n): 'l f r]ry UIS OD'. <br /> 51-9.2`/d <br /> 6.Transporter 1 Company Name U. .EPA ID Number <br /> C RAMOS EWRONMIEfITAL SSERViCES tNC �C{AE)Od/XG5W <br /> 7.TrT�C rte 2 G .f Company <br /> Name cYrs rd l U�P� Number <br /> -L <br /> 8.Designated Facility Name and Site Address U,S,EPA ID Number <br /> VE011A ES TECHNICAL SOLLMON CAT08WI4079 <br /> 1125 HENISLEY STREET <br /> RICHNIOf-M,CA 94881 <br /> Fadlil rs Phone°(&2d3-23K <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class ID Number, 10.Containers 11.Tafel 12.Unit <br /> and Packing Group(if any)) 13.Wasta Codes <br /> HM No Type Quantity Wt/w. <br /> 1-L"319931 WAS F1&rn,"4die 0AA.;_ ,A),0,5., 3, T)F I -iAl <br /> 3 Dao <br /> � I <br /> P6MCILI <br /> sOrJh K.,,�� �yc su.cfar� <br /> LUME 2 LOA TokrC So(.�DS G�6s�4,,3.C,,.]hC3hS, 6.I,�zz` <br /> `, _DF <br /> �C �,L- ,4+7reE nl A C.�f.j r 'O <br /> 3.U-0-2 S81, A I.�-rh.t i nl t��+-r1 C Hj a�hd F I-od .-{�DIJj e, ' ! �y <br /> 4-AJA 303A.,/M74 a7UoLA s L--'�,As• <br /> YPC' LL �xr�rss, CpppE-r+t <br /> 14.Special Handling Instructions and Additional Information r <br /> 981)PROFILES ERG#05 Lp/ru-eras 1 X 54'fL r/o 1613 <br /> E.R CONMCTOR: RJAMOS ENMP,ONMEftA-L SERVICES �'�3 ��' �� IS�J 1 (;4t <br /> RMOLERS SHOULD BE TRAINED AND USE APPROVED PPE <br /> R92PA�F+IEa �2G�fS�J F' c,+FD-00, f X54R1w 76q PAOFL Er�G�'I !xs <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that fhe conlents of this consignment are fully and accurately described above by the proper shipping name,and are classlfied,r <br /> marked and labeiedlplacarded,and are in all respects In proper condition for transport according to applicable International and national governmental regulations.H export shipment and I am the Primary d <br /> Exporter.I certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent <br /> I.om*that the waste minimization statement Identified In 40 CFR 262 27(a)(if I am a large quanSly generator)or(b)YAM a small§Nmty gen r)Is true. <br /> Generato!r!7 <br /> P&7 Nr Signature <br /> 16.International Stop .is <br /> F El Import to U.S. ❑Export from U.S. of entrylexih <br /> Transporter signature(for exports only): �leaving U.S.: <br /> 17.Transportel Admowledgrnent of Receipt of Materials <br /> Transporter 1 PrintedlTyped Name r Sigrhahrr�.� v� Mo D Y <br /> CL I—E a/eInOAI D .�� All A <br /> a Tran r 2 yped Name S Month Oa Year <br /> Iz /,J'/ /7 j," j4 03 17 1i 3 <br /> 18.Dtscrepanry <br /> 18a.Discrepancydndication Spade y ❑ Quan* ❑T ❑Resida 1-1 <br /> ype' , ;fJ Portal Re)edion ❑Full Rejedlon <br /> Manifest Reference Number, <br /> 18b.Alternate Facility(or Generator) U S.EPA ID Number <br /> V ` <br /> Fadlitys Phone: <br /> LU 18c.Signature of Allemate Facility(or Generator) Month Day Year <br /> a � <br /> a <br /> 19.Hazardous <br /> (Waste Rlep�o/rt Management Method Codes(i.e.�rLco�des/far hazardous waste treatment disposal,and re*lIng system) v/ <br /> im <br /> 0.1ftpated Facility Owner or tor.Certification of receipt of hazardous materials covered by the manifest except as 1 <br /> ria Name PZro pay Year <br /> EPA Fon 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />