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Please print or type. Form Aenroved. OMB No. 2050- GENERATOR ). UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number 2. Pager of cikucco 4-12,,9,. LI)2. 3. Emergency Response Phone 315-371-5747 4. Manifest Tracking Number 0 2199 07 6 5 JJK Generator's Name and Mailing Adgrev "i) -,,,.---.- \ \ j ,) \ c Generator's Site Address (if different thin mailing address) t \.CkY\C\ culA t. /0031 thAry) p lir e/y 5 ---k- . vw Por\VLIAA oc, cci-x):D, , , \ (0 . \,CC.-1(- r) 5.03 Generator's Phone: 3G0 - 1-61(') - 3 ‘ (of-D- 1 1 cv4- q Transporter 1 Company Name U.S. EPA ID Number RANIOS ENVIRONMENTAL SERVICES INC. 1 CAI304412.1,-.= Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number RAh,10S ENVIRONMENTAL SERVICES INC. CAD044003555 1515 SOUTH RIVER RD. WEST SACRAMENTO, CA S5531 Facility's PhoneP16-371-5747 1 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes H /A and Packing Group (if any)) No. Type Quantity Wt.Nol. NON RCRA HAZkIRDOUS: WASTE LIQUID (OILY 1.1j.!ATER) oo i rr 1--Er-' /1--' 7_5 " ''-- a 223 14. Special Handling Instructions and Additional Information 2 / 2_ 7 ‘C '111:11DLERS TO BE TRAINED 87.iiL APPROVED E. E.R. CONTRACTOR: RAMOS ENVIRONivlENTAL SERVICES 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international 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 262.27(a) (if I am a large quantity generator) o if I described above by the proper shipping name, aid are classified, packaged, and national governmental regulations. If export shipment and I am the Primary m a small quantity generator) is true. Generator's/0 r PrinVd/Typed New, ,..., Signatur k- b lAti‘ le.., '.,A,(ALA IV- Month Day Year ,1 ) L -----..-, I / 1 ILA 2-1 i-- 16. International Shipments Import to U.S. Export from U.S. Port of entry/exit: Transporter signature (for exports only) Date leaving U.S.: ce .. 17. Transporter Acknowledgment of Receipt of Materials TRANS PORTE Transporter 1 Printed/Typed Name Signature .. Al.Sor 6::1;,..!--- I -/-6:7-1,:s", 1/ Month Day Year 1//12/ Transporter 2 Printed/Typed Name Signature / Month Day Year I I I I DESIGNATED FACILITY -> 18. Discrepancy Discrepancy Indication Space EI Quantity Type Residue Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. Mg i 2. 3. 4. 20. Designated Facility Owner or Operator: Certificatio of receipt of haz ous materials covered by the manifest except cled in Item 18a PrintedITyped Name . Signature Month Day Year .. A_ Sc a --. I I #0g4.4 Sitlle? 101 1/5 14 EPA Form 8700-22 (Rev. 1217) Pr ious editions are obsolete. DESIGNATED FACILITY TO EPA's e-MA IFE S