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<br /> J�'FWASICNANIFEST
<br /> S i . Generator ID Numbor 2. Page 1 of 3 Emergctiney Response Phono 4, Manifosl Tracking Number (� y g yy
<br /> c (J1 D18.371�5747 ® 5 658449 e. JKaUNgAddross ConeraloysSilaAddress (ItdllforenlihenmalMgaddross)etcwR �. r�; a yv � , . 'M e4� ` --
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<br /> Gonoralora Phonewlgk. ol.• '' @ 1� �
<br /> 6. Transpodm i CompanyNama U•S. EPA ID Number
<br /> RAMOS ENVIRONMENTAL SERWE—u iNC, CAD+)d4003556
<br /> 7, Transporter 2 Company Name — _ _ - r T. . ,4 . �.,_ m,_Y
<br /> U.S. EPA Number
<br /> Be Designated Facility Name and Site Address
<br /> RAW$ 1 NV1RONtv1EP}TrSd , SGRVICte`; INC.
<br /> U,S. I PAIDNunafmr
<br /> 1515 SOUTH RIVER .R0.1
<br /> Diti 371 5717 WE51" SACRA,tv1E1dCC7 , CA; 95691
<br /> " • Fao6h+s phone: � ___ • _
<br /> ga, Ob; U.S• Of DoscrtpUon (including Proper Shlppiug Namo, Hazard Class, 10 Number, 110, Conialners
<br /> HM and Packtrtg Group (if any)) I lot . Total 12, Unit 13. Whsle Codas
<br /> No, Type ., Quantity WLNoi,
<br /> is NuNtRCRA 'HA?ACtDuUS UUASTE . ciUID. (115FR. ANTIFRGEf` � a
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<br /> 14, Spedat HandFng tnsWcBons end Additional information
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<br /> EeRb CONTRACTOR: RAMOSI ENVIRONMENTAL SERVICES
<br /> HANDLERS TO 9EITRAINED AND USE APPROVED PPE,
<br /> S. GENERATOR'S[OFFEROR'SCERTIFICATION: Iherebydeciarethatthecontentsofthisconsignmentarefullyandaccuratelydescribedabovebytheproperslippingname, andarectassified, packaged,
<br /> mated and labeled/placarded, and are In all respects In proper condition for transport according to applicable Intemationals lions[ governmental regulations, It export shipment and I am the Pdmary
<br /> Fxpoder, I cari4 that the contents of Us consignmentconform to the terms of the attached EPAAcknovdedgmenl of Cdrise
<br /> I cerlifY that the waste rNAlmization statement identified In 40 CFR 262.27(a) PI'l am a large quantity generator) or (q),W) amasmallquanllly n alor) ISWe.
<br /> 00WOM Pr4htodrlyped Neme Signatureottef11h pa Yea
<br /> - e; 16, inlomauonal Shipments NJ
<br /> r- ❑ Import to U.S. ❑ Export ora U.S, t ort of en x11: t
<br /> ? TransportOrslgnaturo (forexpelsonly)t atin9US.:
<br /> 11. TrartsporterAeMoWedgmg6to( Receiptof Maledals
<br /> Transporter 1 PdntedrTyped ame Signature f r Month pay Year
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<br /> QTranspo Med/Typad Rome Slgnatme Month pay Yaar
<br /> i8. Discrepancy
<br /> 18a, Disciepancy IndloaBoo Space
<br /> 1:1 Quantity ❑Typo ❑ Residue ❑ PartialRe)ecUon ❑ Full Rejection
<br /> Manifest Reference Number.
<br /> 18b, Ailerpate Faciiity (or Generator) UA EPA ID Number
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<br /> Fac% s Phone;
<br /> r18aSgn turaolAllerr l! Faplity (orGeneralot) 14 Monlh Day Year
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<br /> 19, Hazardous Waite Report Management Method Codes p,e„ codes for hazardous waai. treatment, disposal, and recycling systems)
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<br /> 20. Designated Facigy O,vnor orOpetalot: CorUrreatlon of iecefpl of hazardous meledais covered by the manifest excepl ps tided In Item 18a )
<br /> Pdriled[TyPIName signature i
<br /> 1 Month Day Year (.
<br /> EPA Form 87a -22 Rau 3.05) t'reviouseditions Hoobsoleta, DEW At EI) FACILif DCSTINATION S1'WE (IF R>~GiIJIn ED) E
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