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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 CAt0004MM 11 918-371-5747 0204,45105 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) ``` J&H MARINE REPt4R 401 N SAN JOSE . STOCKTON,CA 95203 Generator's PhonE209-$96-$716 6.Transporter 1 Company Name U.S.EPA ID Number RAMOS ENVIRONMENTAL SERVICES INC. CADS 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number RAMOS ENi/RONMlENTAL SERVlGES INC. . Cr, ` 1515 SOUTH RIVER RD. WEST SACRAMENTO,CA 95B91 Facility's Phone:916-371'5747 ga, 9b.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 HAZARDOUS WASTE SOLID (OIL,DEBRIS) air, P %2 Z 2. W (9 3. 4. 14.Special Handling Instructions and Additional Information 98-1)PROFILEV LRC*171 "0C') q_ E.R. CONTRACTOR: RAMOS ENVIRONMENTAL HANDLERS SHOULD BE TRAINED AND USE APPROVED PPE 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 small quantity generator)is true. Generator's/Offeror's Printed/Typed NameSig lure Mori h Day Year 2(C_ �CS C 6 �� 1, 1 16. nternational Shipments F- ❑Import to U.S. ❑Exportfrom U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of MaterialLUs tE Transporter 1 Printed/Typed NameSignature Mon DayVY ar CL a Z Transporter 2 Printed/Typed Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Typej j ❑Residue Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: H18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z ` ✓ 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. C 1vit 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 I I I ' 6i EPA Form 8700-22 ev.12-17) Previous editions are obsolete. DESIGNATE ATOR