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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST �� ®19 11&,R1.57A7 Tr ' C52JJ K 5.Generator's Name and Mailing Address r f r i ,_t i Orator's Site Address(if different than maiting address) L001 GAS STORAGE PO P.O. BCOf 230 232E6 N 1-1b 99 ACAMPO,CA 9SM ACAMPO,CA 95220 Generators Phon mpa 6.Transporter 1 Cony Name U.S.EPA ID Number 1 RAMOS Eh1 RONMENTAL 3ERIV10ES INC. CAOC44003655 7.Transporter Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number RAMOS ENVIRONMENTAL SERVICES Ill CAD04400 1515 SOLITH RIVER RD. WEST SACRAMEWTO,C4 96691 Facility's Phone 9l6-371-5747 ga. 9b.U.S DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12,Unit 13.Waste Codes HM and Packing Group(if any)) No Type Quantity Wt.N01. 1" FON RCRA HA7ARDOLIS WASTE SOLID (OlL,DE51 +L— P M c� 1 C-F /.S 71 2.1,10,( k CrP,¢ f� y it S old 3, n. 14.Special Handling Instructions and Additional Information ��z l r� l7 �z o-f-7 9&1)PRO OLE# 19218 ERGM71 �� r J x C- (6 E.R. c0917RAC•f'OR: RAMOS EftiMRONi!t ENTAL Q.0 FLWLER5 TRAINED AND USE APPROVED RPE. 15. GENERATOR'S10FFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accufately described above by the proper shipping name,art are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicabte international and national governmental regulations.]I 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)(if I am a smalluan aerator)is true. Generat0r'sl0fferoes PrintedlTyped Name Signature Month Day Year /Z�, 4e- _j 16.International Shipments F ❑Import to U. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedffyp ame S_ignature Month Day Year Z Transporter 2 PrintedlTy a Signator Month Day Year 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity, ❑Type ❑Residue ❑Fatal Rejection Ll Full Rejection J Manifest Reference Number: i 18b.Alternate Facifrty(or Generator) U.S.EPA ID Number J is Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a 1 z 19.Hazardous Waste Report Management Method Codes(i.a.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. 4. 1 " it -1 + 141 " 1 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Nam Signature Month Day Year ✓ -- 7 ( moi BPA Form 8700-22(Rev.4 -17) Previous editions are obsolete. DESIGNATED FACILITYTU GENERATOR