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VolDTSC.. Ql 181— 24S2 <br /> Tease print or type.(Form designed for Use on elite(12-Ditch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS IJ.dm,,raffal Number 2.Page 1 of 3.Emergency Response Phone 4.MarTracking Number <br /> WASTE MANIFEST - CAD98241-5,481 001067808 G B F <br /> 5.Generators Name and Mading Add. Genet o s ,m kc.filas different than marling address) <br /> PARADISE PT ENG & BOAT REP- <br /> S090 RIO BLANCO RD <br /> G%jQftN. CA 95201 <br /> 6.Transputer 1 Company Name U.S.EPA ID Number <br /> 7.TranspoMrl Company Name <br /> U.S.EPA fU Number <br /> 8.Desgnated Facility Name and Site Address U.S.EPA ID Number <br /> CRI Recycling Service Inc WIR000029751 <br /> 101 Hagen Dr <br /> Agwdbi le, YVI 54028 800-241-2004 <br /> gra 9b.U.S.DOT Description(receding Proper Shipping Name,all Class,ID Number. 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity yfl <br /> 1. <br /> K <br /> felon-RCRA Hazardous Waste Solid DIM P <br /> i 2. <br /> W <br /> 47 <br /> 3, <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Weprr Protective Clothing and Eyewear. 9.1 -OILY ABSORBENT E.R.G.-9.1 #171 <br /> f <br /> ;15.cGENERATOR'S/OFFERORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping came,and are classified,packaged, <br /> marked and IabekNplacarded,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 he attached EPAAdmoMedgment of Consent. <br /> I certiy that the waste minimization statement identified in 40 CFR 262.27(a)(ff I am a large quantity generator)or(b)(itI am a small quantity generator)is true. <br /> Gene bIslOderWS Pen Na a S' aWre nth Day Vear <br /> rtb, z Z� 09 <br /> 16.International Shipments ❑Export from U.S. Port of en mxie <br /> H Import to U.S. try <br /> = Transporter signature(tor exports only): Date leaving U S.: <br /> w 17.TramporterAdmowledgment of Receipt of Materials <br /> TmnpWw 1 Printed7Typed Name Sgn Month Day Year <br /> y <br /> h1 lc Z t( o <br /> Trans0orter2Ponted7Typed Name Si nature Monty Day Yea <br /> r <br /> 16.Discrepancy <br /> t8a.Discrepancy Indication Space ❑Type ❑R ❑ I ElFullRejection <br /> ❑ Quantity T e esidue Partial Rejection <br /> Manifest Reference Number: <br /> i6d Alternate Facility(or Geneml U.S.EPA ID Number <br /> J <br /> U <br /> LL Fachly's Phone: <br /> w 18t.Signature of Alternate Facility(u Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e..codes for hicardous waste treatment disposal,and recycling systems) <br /> 1. 2. 3. d <br /> 20,De�sgnated Facility Omer w Operator:Certification of receipt of harardous materials covered by the marl xcept as noted 4) 18a <br /> 11 <br /> Maine <br /> Name SgwNre Monty Day Year <br /> knw <br /> 5 <br /> PA Form 8700-22(Rev. 5) Previous edidonsliam obsolete <br /> 10650.1155iSIGNATED FACILITY TO LTOATION STATE(IF REQUIRED) < <br />