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Please print or type. FoniiAnoroved. OMB No. 2050-0039 4 GENERATOR . UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />CAL000305222 <br />2. Page 1 of <br />2 <br />3. Emergency Response Phone <br />916-371-2570 <br />4. Manifest Tracking Number <br />023612976JJK <br />Generator's Name and Maili g Address Generator's Site Address (if different than mailing address) <br />RAMOS OIL CO THORNTON 8925W THORNTON RD <br />PO BOX 401 THORNTON CA, 95686 <br />WEST SACRAMENTO CA, 95691 <br />Generator's Phone: 916-371-2570 I <br />Transporter 1 Company Name U.S. EPA ID Number <br />RAMOS ENVIRONMENTAL SERVICES ICAD044003556 <br />Transporter 2 Company Name U.S. EPA ID Number <br />ECO TRANS LLC 1 CAR000242050 <br />Designated Facility Name and Site Address U.S. EPA ID Number <br />PACIFIC RESOURCE RECOVERY SERVICES INC CAD008252405 3150 EAST PICO BLVD <br />LOS ANGELES CA, 90023-0000 <br />Facility's Phone: 800-499-7145 I <br />ga. 9b. U.S. DOT Descripfion (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br />Fim and Packing Group (if any)) No. Type Quantity Wt.Nol. 13. Waste Codes <br />1. RQ UN1325, WASTE FLAMMABLE SOLIDS, ORGANIC, N.O.S. 4.1, PGIII (GASOLINE, D018 D001 DEBRIS) (D001) 7 1 DM 165 P <br />352 <br />2. ri <br />- <br />3. <br />-I <br />4. <br />.--.1 <br />14. Special Handling Instructions and Additional Information <br />Line 1: <br />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, <br />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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />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. <br />Generators/Offeror's Printed/Typed Name Signature Month Day Year <br />JULIO PEREZ 1 JULIO PEREZ 1 11 1 22 1 2021 <br />-i <br />r- <br />3 <br />16. International Shipments II Import to U.S Export from U.S. Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: TR ANSPORTERI 17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name Signature Month Day Year <br />JULIO PEREZ 1 JULIO PEREZ 1 11 1 22 1 2021 <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />ILLEGIBLE 1 ILLEGIBLE 1 11 1 29 1 2021 I 4- DESIGNATED FACILITY --0. I 18. Discrepancy <br />Discrepancy Indication Space III Quantity EITYPe Residue Partial Rejection Full Rejection <br />Manifest Reference Number: <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) Month Day Year <br />I I I <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. <br />H141 <br />2. 3. 4. <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Typed Name Signature Month Day Year <br />ELAINE HUZAR 1 ELAINE HUZAR I 12 I 06 I 2021 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM