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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL ooc,. sbS 1 916-371-5747 10229950`56 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) lz4mos o,L co. T-1 tneja � 1515 sou- -A Q' VQ- Rnrb 7-9P ,JJ(ID AJ RtAb w6w'-+-s ,QArrrE+�l�,c,�. Generator's Phone: 3711- 6. 1-6.Transporter 1 Company Name U.S.EPA ID Number Ramos Environmental Servic-'s Inc. C A D 0 4 a 0 0 3 5 5 6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Rams Environmental Services Inc. 1515 S Rarer Rd. 'West Sacramento CA 95699 Facility's Phone: Al R R71-5747 d n n } Fi ga 91b.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 1 NON RCRA HA ARDOUS'AlASTE SOLID(SOIL,DEBRIS) Z 2. W 3. 4 14.Special Handling Instructions and Additional Information 1)9131)PROFILE# ERG#171 HANDLERS TO BE TRAINEDAND USEAPPROVED PPE.E.R.CONTRACTOR: RAMOS ENVIR0NIb1ENT.AL SPJIL aS a �if qg 3 X554A S 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 for transport according to applicable intemationaland 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 262.27(a)(if I am a large quantity generator)or(b)(if I am a small qu enerator)is We. Generators/ Her PrintedlTyped ame Signature Month Day Year 4Q- 16.Intern conal Shi ents FLl Import to U.S. ❑Export from U.S. Port of entrylexit ? Transporter signature(for exports only): Date leaving U.S.: W 17,Transporter Acknowledgment of Receipt of Materials LU I-- Transporter 1 Print /Typed Name Signature Month Day Year O a Z Transporter 2 Print /Typed Name Signature Month Day ear F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity Type ❑Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: C3 18c.Signature of Altemate Facility(or Generator) Month Day Year F- Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1. 2. 3. 4. 1 120.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 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. I)P;Sh';;.i;1'f fl-D FACILITY TO U"A's e-MANIF-,,:33 I Y3Y-N]