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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) FormADproved.OMB No.2050-0039 UNIFORM HAZARDOUS 1'G.01 I240r S/1oq6a2.Page Tof 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST eA a �► . 16.371.6747 017145974 JJK 5.GeneraloCs Name and Mailing Address Generators Site Address(if different than mailing address) RAMOS OIL CO.-STOCKTON PO BOX 401 ATTN:JOY KACHADORAIN IMS NAVY DR. WEST SACRAMENTO.CA 95691 ST'OCKTON,CA 95703 lGeneraloes P 6.Transporter 1 Company Name U.S.EPA 10 Number RAMOS ENVIRONMENTAL SERVICES INC. CA0044OD3556 7.Transporter 2 Company Name U.S.EPA ID Number L L N 1.-t� G. 12 0 0:, J 8.Designated Facility Name and Site AddressPACIFIC RESOURCE RECOVERY U.S.EPA ID Number 3160 EAST PLCO BLVD. CA000825M LOS ANGELES,CA 90023 Facility's Phone=�499-7145 aa. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WINoI. 13,Waste Codes � t UN1203,WASTE GASOLINE,3,PGH 0 G 331 b001 D018 c� 3. i i I 4. I 14.Special Handling Instructions and Additional Information Ml)PROFnESCi-Dganij RGN128 ER • RAMOS E ONMENTAL HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE 15. GENERATOR'SrOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassikd,packaged, marked and labeledlplacarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(f I am a large quantity generator)or(b)(dl a all quantity generator)is We. Generators=emrs Prirdedfryped Name Signature Month Day Year v eA Q�_ I I `l I rt I /7 t 16.International Shipments Z ❑Import to U.S. ❑Export Port of entry/exit: Transporter signature(far exports only): Date leaving U.S.: L L17.TransporterAdmowledgment of Receipt of Materials Transporter 1 rintedlfy ame O gn re Month Day Year QT n er 2 rime ped Name Signature Month Day Year J�: 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑ ❑ ❑ Type Residue ❑Partial Rejection Full Rejection Manliest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number _J V 'I- Facility's Phone: w 18c.Signature ofAltemate Facility for Generator) Monty Day Year Q Z t� 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 a ' i i ,n�j 2• T 4. Ll20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PdntedlTyped Name Signature MonthDay Year L_ nu • Wrm1v__<g I a-A&&L 1 -71 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGN ATEG FACILITY T 1 DESTINATION STATE(IF REQUIR D)