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AUG-14-2008 07:24A FROM: TO;4683433 P.2 a Please print or type.(Form designed for use on elite(12-pitch)lypevaiter) Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS.71 ID Number 2 Page 1 of 3.Emergency Response Pitons 4,Manifest Tracking Number WASTE MANIFEST G BF 5.Generators Name and MailingAddress G6MRA—SWA ifferent than mailing address) VILLAGE WEST MARINA- "EMBARCADERO DRIVE AMMMN CA 96219 6.Transporter 1 Company Name 2W4)51-1551 U,S.EPA ID Number U . 8.Designated Facility Name and Gila Address U.8 EPA 10 Number CRI Rearalinq Selivice Inc WIR000029751 101 Hanen Or ga 9b.U.S.66T escriptiort 1 ndud ng er 5fn Propipprtg Name,Hazard Class,ID Number, 10.Cotda€nera 11,Total 12.Unit 13,Waste Codes HM and Packing Group(if arryl) No. Type Quantity Wt.Nol 1. OC Non-RCRA Hazardous Waste Solid M P g 2. w 3. 4, 14.Special Handling tnstrucfbns and Additional Information Wear-Pirvtective Clothing and Eyewear. 9.1 -OILY ABSORBENT E.R.G.-9.1 #171 15. GENERATOR'SfOFFEROR'S CERTIFICATION; f hereby declare that the contents ofthls conslgnment are fully and aocuratety do=IbWabmra by the proper shipping name,and are classified,packaged, marked and fabeledrplararded,and are In all respects In proper rwnditlon 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 identif ed In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneretorsfOtierors Prinledffyped Name Signature rMo Day Year M ;�- ✓ 1 cad 16.International Shipments ❑Import to U.5. ❑Export from U.S. r` Port of entrylexit: Transporter signature(for exports onlyp Date leaving U S W 17,Tra Acknowledgment of Receipt of Materials 97 d Pretret i d Name S' a e Month Day Year C�,I� AJ 8 /3 cIke 1TrFnsporter2 PdniedfTypad Name Signature Month Day Year a 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rajaclidn ❑Full Rejection Manifest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number U LL Facility's Phone; W 18c,Signature ohAltemareFa6lity(arGenerator) Month Day Year 19,Hazardous Waste Report,Managemant Mothod Codes((.e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1. 2. Ll2 . ted F=Ay Owner or Oparmor Cartifrcation of receipt of hazardous materials wvared by the manifest except as noted in Item 18a PdntedRyped Name Signature Month Day Year EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. DESIC NAMED FACILITY TO OMNERATOR STATrE OF REQUIRSD)