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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFESTCAFiCiIDLl 1 S k16-W 1 r fi 02.�. 3`1572 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) L.ODI CCAS STORAGE-ACAMPO 232PJ i�VY P.O. BOX 23D 99 ACAt�APO.CA AC�#,dRs:U,?;A. 'tea Generator's Phone- 6.Transporter 1 Company Name U.S.EPA 1D Number RAMOS EAMRC>!NMENTAL SERVICES INC, CA0044 6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number RAMOS ENVIRON&!El�TAL SERVICES INC. 1515 SOUTH RIVER RD. WEST WRAMENTO,CA 9%g1 Facility's Phone:916.371-5747 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)} 13.Waste Codes No. Type Quantity Wt.Nol. C 1. NON RCRA HAZARDOUS WASTE SOLID (OIL,. DEBRIS) z 2. w C7 3. 4. 14.Speciai Handling Instructions and Additional Information 9B1)PROFIL.E9 ERGM71 VEvr�o! LA HAMXERS TO BE TRAINED AND USE APPROVED PPE_ E.R. CONTRACTOR: RAMOS ENV RONMENTAL SERVICES 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and aw'u'rafely described above by the proper shipping name,and are classified,packaged, marked and labeled)placarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of tNs consignment conform to the terms of the attached EPAAcknowledgment of Consent. 111 I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(KI am a sm I quantity generator)is true. Generato sfOfferors Printed/Typed Name Signatu�- -�- Month Day Year 16,Intema4onal ShipmentsJ757161 - F ElImportto U.S. ❑Exporfhom U.S. Pon of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedffypeNawe Signature ^--�` _ Month Day Year CL / U ^7 I 7c aTransporter 2 Printedfryp Sigriafure Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space El Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U,S.EPA ID Number _J V LL Facility's Phone: in I LLJ 16c.Signature of Altemate Facility Jar Generator) Month Day Year a z r, 1g.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Q 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materiais covered by the manifest except as noted in Item 18a Printedl7yped Name Signature Month Day Year ,[_ vc - _ S -7 d,, EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FAQLITY TO GENERATOR i