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Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.205HO39 UNIFORM HAZARDOUS 1 1.GeyterAtcy ID Numhery� �/ 2.Page 1 of3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST aok �- 16,371-6747 1 017145974 JJ K 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) RAMOS OIL CO:STOCKTON 1505 NAVY DR. PO BOX 401 ATRd.JOY KACHADORAIN STOCKTON,CA 95203 WEST SACRAMENTO.CA 991 Geneator's P 6.Transporter 1 Company Name U.S.EPA ID Number RAMOS ENVIRONMENTAL SERVICES INC. CADD44ODS555 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and She AddressPACIFIC RESOURCE RECOVERY U.S.EPA ID Number 3180 EAST PICO BLVD. CA00082M405 LOIS ANGELES,CA 90023 Faciiitys PhonePW499'7145 ga, 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 Wt.Nol. 13.Waste Codes 1. UN1203,WASTE GASOLINE,3,PGOI G 331 4018 o _ Z 2. LUi 3. 0 I 4. ii i i s 14.Special Handling Instructions and Additional Information E.R CONTRA RAMOS ONMENTAL HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledfplacarded,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)(if I am a large quantity generator)or(b)(11 a all quantity generator)is true. C-eneratot's106era's Pdrdedtfyped Nam Signature Month Day Year et1 ? r l l 7 j 16.International Shipments ❑Export fro Port of en lexit, i- ❑Import to U.S. try Z Transporter signature(for exports only): Date leaving U.S.: LQ: 17.TansporterAcknoMedgment of Receipt of Materials Transporter 1 Pdniedfry ame gn re Month Day Year Z T n erg PrintedfllypedName Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ QuanMy Type ❑Residue Paai Rejection on ❑Full Reiection Manifest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number J U< Facilitys Phone: w 18c.Signature of Alternate Facility(or Generator) Month Oay Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. i r �.�I 2. 3. 4T, VTU 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedlryped Name -S 1 li�1 7 t-X,. �� lSignature Mon Day Year }I 7 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNAT FACILITY TO DESTINATION STATE(IF REQUIR D)