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Please print or type. . Form Approved.OMB No.2050-0439 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Emergency Response one 4.Manifest Tracking Number WASTE MANIFEST CAFKE0242149 1 915-371-5747 020,3190939 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) OO, HC3X OX 230 STQRAGE ACAMPO P.O. 232 N HWY 99 fr2tiaAr A vc w�S • P ACAMPO,CA 95220 Generator's Phcna-%36B M MI fi.Transporter 1 Company Name' J.S.EPA ID Number RAMOS ENVIRONMENTAL SE"CES INC. v 0 9 2019 CAUDd 56 7,7-ransporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address Y U.S.EPA ID Number RAMOS EN'�RONMEfdTAL SERVICES t 1515 SOUTH R!`JER RD. CAD044035% WEST SACRAMENTO,CA 95591 Facility's Phone.-916-371 X747 ga, 9b.U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1f Total 12.Unit HM and Packing Group(d any)) I 13.Waste Codes No, Type Quantity W1.Nol. 1. )VON RCRA HAZARDOUS WASTE SOUR (OIL, DEBRIS) P 352 a Z z 3. 4 14.Special Handling Instructions and Additional Information 3 35-1)PROFILEO ERG9171 �0.6 'e— E.R. CONTRACTOR: RAMOSE EWORNMENTAL HANDLERS SHOULD 13E TRAINED AND USE APPROVED PPE VD m:29 9, 15 GENERATOR'S10FFEROt2'SCERTIFICATION: Thereby declare that the contents of this consignment are fully and acxurately des above by the pro shipping name,a d are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport awarding to applicable Intematiionaland nalul ns.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Cons 1 certify that the waste minimization statement identified in 40 CFR 282.27(a((if i am a large quantity generator)or(b) am a s gen )is true. Generators) eroes Printedl7�d Name Sigpature Month Day Y CA'nC,f- r�L` 16.international Shipments Ij„_ ❑Import to U.S- ❑Export from U. o entry)-it: ? Transporter signature(for experts only): ate aving U.S.: IX W 17,Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Signature n Day Year a USS P9C` 'f 2, zTransporter 2 Prinledrryped Name- Signature Month Day Year F-- 18-Discrepancy 18a,Discrepancy Indication SpaceEl ❑Full Rejection Quantity Ll Type ❑Residue ❑Partial Rejection' Manifest Reference Number: 18b.Altemale Facility(or Generator) U.S.EPA 0 Number C) ti Facilitys Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Z tR- n19.Hazardous Waste Report Management Method Codes(l.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU t 2. 3. 4, 20.Des gnated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedfiyped Name Signature Month Day Year 23 11 1i EPA Form 8704-22(Rev.12-)) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR