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, Please print or type. ;. Form Approved.OMI3 No.2050-0039 UNIFgRM HAZARDOUS 1 Generator ID Number 2.Page 1 a# 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST c 42149 11 16-371-6747 020445745 JJ K 5,Generator's Name and Mailing Address 1(�-,DAj Generators Site Address(if different than 952]4 madiingaddress) LII GAS:31'QR: 3E-AC}iMlr+t7 tam N HWy 55 Fes,-)-kt GE ACAMPO,SCR P.O. I 234 ACAMPO,CA 9620 _ Generator's Pho E-Transporter 1 Company Name U.S.EPA ID Number RAMOS EWRONMENTAL SERVICES 1NC. CADOM015i 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address R OS EWRONMENTAL SERVICE U.S.EPA ID Number 1515 SOUTH RIVER RD. CA004400305 WEST SACT'MEWO,CA 9%41 By Facility's Phone.5n&371-5747 1 j ga 91i.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 Ix 1 Nl'71# Ii HAZARDOUS WASTE SCUD (OIL, DEli D o� Cr 0 z 2 L It 3. 4. 14-Special Handling Instructions and Additional Information 90-I)PROF111i ERI E.R. CONTRACTOK RAii 1=NVIFtONMENTAL X of HANDLERS SHOULD BE TRMED AND USE APPROA/ED PRE 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 labeledlplacarded,and are in all respects in proper condition far 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 21(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Ge I.i slOfferor's Printedfryped Name Signature Month Day Year M J 16.International Shipments ❑Import to U.S. ❑Export keffi Port of entrylexipt ? Transporter signature(for exports only): Date leaving U.S.'. W 17 Transporter Acknowledgment of Receipt of Transporter 1 P nted Typed Name Signatu / Month Day Year O r loll D Z- z Transporter 2 Printe yped Signalur — Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full RejWion Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V wa- Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year a z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2 3. 4. 1 20 Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrinledlTyped Name Signature Month Day Year ,-A 'C e— EPA Form 8700-21J 700-22 f ev.12-17? Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR