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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS (� 2.Page 1 of 3.Emergency Response Phone 4.Manif((esst Trac�ki}ng/—Number � r p WASTE MANIFEST Ao. u02 V 93l1659-977-6202 J®0 4 117 /I 7j G D F 5.Generator's Name and Mailing Address Generator's Site Address(if different than marling address) Y [ PICK-N-PULL SB'0- 3927 CLARK DRIVE STOCKTON. CA 996M-M1 Generator's Phone: _ 6.Transporter 1 Company Name U.S.EPA ID Number CII Recycling Service Inc I WIR000029761 7-Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA 10 Number CRI Reewlifna Service Inc WIR0000297 61 101 Hapen Or FMV90W le, 1M 54M SM 241-2ii 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)) 13.Waste Codes No. Type Quantity Wt Not. 1. Nan-RCRA Hazardous waste Solid DM P Z 2. c� 3. 4. - 14.Special Handling Instructions and Additional Information Wear Protective Clothing and Eyewear. 9.1 - OILY ABSORBENT E,R.Ci--9-1 #171 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 Iabeledfplacarded,and are in ail respects in proper conditior 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 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)am a small quantity generator)is true. GeneratoeslOfferoes Printed rryped Name Signatures_ Month Day Year. —ill 6 Int0mational Shipments ❑Import to U.S. ❑Export from U.S. Port of entryfexit: Transporter signature(for exports only): Date leaving U.S.: W 17.TcansporterAcknowledgmenlofReceipt ofMaterials Fe Transporter I Printeciryped Name ` Signa Month Day Year 0 L5 14 U- nLo 66, a Tilani 2 Printedr ryped Name Sig tura Month Day Year 4Y r 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pallial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA rD Number J C} _ LL Facility's Phone: Q 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Fn 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1. 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 Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED)