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Please print or type. Form A roved. OMB No. 2050-0039 A cK P <1 w ui z al 0 UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number b CAL000422932 2. Page 1 of 1 3. Emergency Response Phone 916-371-5747 .. 4. Manifest Tracking Number 021990765JJK Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) ROSS ISLAND SAND & GRAVEL CO. 1003 HUM PHREYS ST PO BOX 82249 STOCKTON CA, 95203 PORTLAND OR, 97282-0249 Generator's Phone: 503-239-5504 I Transporter 1 Company Name U.S. EPA ID Number RAMOS ENVIRONMENTAL SERVICES ICAD044003556 Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number RAMOS ENVIRONMENTAL SERVICES CAD044003556 1515 S RIVER RD. WEST SACRAMENTO CA, 95691-0000 Facility's Phone: 916-371-5747 I 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit Codes 13. Waste Km and Packing Group (if any)) No. Type Quantity Wt.Nol. 1. non RCRA hazardous waste liquid (oily water) -- 1 IT 725 G 223 2. 3 4 14 S ecial Handling Instructions and Additional Information Line 1: 15. GENERATOR'S/OFFEROR'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 labeled/placarded, and are in all respects in proper condition for 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 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 small quantity generator) is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 01 I 14 1 2021 _.1 z 16. International Shipments Import to U.S Export from U.S. Port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year Ii m 01 1 14 1 2021 Transporter 2 Printed/Typed Name Signature onth Day Year I I I I .(-- DESIGNATED FACILITY -0- 18. Discrepancy Discrepancy Indication Space III Quantity laPe 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 I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. H141 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year john villanueva I john villanueva 1 01 1 15 1 2021 EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM