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Please pint or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS i Generator ID Number r� 2.Page 1 of 3.Emergency Response Phone 4.ManlfesttTTr,,kktn�Number c WASTE MANIFEST CAL cki>5��rti ! 918 371-5747 U ? / _7 .i v 3 J C, JJK 5.Gensralor's Name and Mailing Address Generator's Site Address(if different than mailing address) ?A,nos o.Z. co. T-A=CAA-013 h a 89-25 41 TNCVC�AJ 72Z44.D 1515 Sou'Tl�1 Q•tdt°Q, Gl 9569 I 7-#W,J70,J, d4.9S6 S4 Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number Ramos Environmental SerJc.e_lno. C A D 0 4 4 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 Ramos Environmental Services Inc. 1515 S River Rd. West Sacramento CA. 95891 Facility's Phone: Q 1 R '471_r)747 oa. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Coup(if any)) No. Type Quantity Wt./Vol. 13.Waste Codes 0 1 NON RCRA HAZARDOUS V ASTE SOLID(Oil-,DEBRIS) 52 j W z 2. W 3. I 4. 14.Special Handling Instructions and Additional Information y-- 1)991')PROFILE# ER.G#171 HAPIDLERS TO BE TRAINED AND USE APPROVED PPE.E.R.CONTRACTOR: PAMOS ENVIRNMENTAL s i c. S a' �f qg 3 x556�A� �rnS 15. GENERATOR'S10FFEROR'S CERTI ICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,aid are classified.packaged, marked and labeled/placarded and are in all respects in proper condition for transport according to applicable internationaland national governmental regulations.If export shipment and I ani the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent. I certify that the caste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ill am a small Su .generator)is true. Generators/ er Printed/Typed ame Signature Month Day Year �L 16.Intem .ional Shi eels Import to U.S. ❑Export from U.S. Port of entry/exit: _ ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter t P int /Typed Mame Signature Month Day Year O a Z Transporter.Print /Typed Name Signafire Month Day —Year— F- 18. ear Q F- H 18.Discrepancy 181.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F} 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility;Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e„codes for hazardous waste treaGnent,disposal,and recycling systems) Ll 0 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrfyped Name Signature Month Day Year v V rrNv -/ moi'" 111 110 3 17-2- EPA Foini 8700 (Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM