Laserfiche WebLink
Sep 16 09 0139p Dawn Wickman 715-_ 3485 p.2 <br /> Please print,or IyFe.(Form designed for ase on elite(12-pitch!lypew'rdar.) Form Apprcved.OMB No.205-003 <br /> UNIFORM HAZARDOUS 1 Generator ID Numbor 1.Pace f of 1.EnNrgency R�spmse Phone 1,Manlfesl racking Number (� <br /> WASTE MANIFEST _ _ 000332307 �-+ <br /> BF <br /> S.Generalpfs Mary and Mai Addy-ss Ger4ralor's Sire Address(if 4derent than maillrig aCd,ess) <br /> KRAGEN AUTO-1432 <br /> 309 W CHARTER WAY <br /> Gee�oRrsonFpN. CA 95206 am 442-6QQQ <br /> 6.Trarsporw-I Company Nam U.S.EPA 10 Number <br /> CRI Recy-ding e Rx7it <br /> ■�R\ V 020 <br /> T.Trar spotter 2 Company Nave US EPA ID Number <br /> 8.Designated Ft i(y flame and Sita Address U.S.EPA ID Number <br /> CRI Recyclinpi Service Inc WIR000029761 <br /> 101 Hapen Dr <br /> FaW}btgdyylle, WI 540` 241-2004 <br /> ga 91;.US.DOT Description(IncludingProp er ShON Marna,Hazard Class,ID Pkimber, 10.Containers 1t.Total 2.Unit ;3.Waste Codes <br /> HM and Padav Group Of any)) No. Typ9 Duar1ty Wt Nd. <br /> 1. <br /> 023 <br /> Non-RCRA Hazar us Waste Solid DM 'j,,7 P <br /> a 2 <br /> w <br /> 3. <br /> I <br /> I <br /> 4. <br /> I <br /> 14.Special Handing Insfru�ftns and Addition Infornaticn <br /> Wear Protective Clothing and Eyewear. 9.1 - OILY ABSORBENT E.R.G--9.1 #171 <br /> 5. GENERATOR'SiOFFEROR'S CERTIFICATION:I hereby dedare tha!the contents of tNs Corsi e.nrnaM aT fully and accurately cescrbed above by the proper shipping name,and are classifi3d,packegec, <br /> rarkad and labefed,'pla©rded,and are in all respeas In"at conldion for Irarspert acccrding'.I applicable intemai and nation3t governmenlal reguta?ons.If exrod shipment and 1 am Vie Primary <br /> ;xpore%I certify that lie ocnients of this consignment conform to the tarrns of the a,[ached EPA AcknorAcdgmenl of Censera. <br /> I certify Ilia:the waste minim¢a6on slate mord identified in 4fi CFR 202.27(3)(.f I am a large quantity ganaralor)or(b)(if I am a:mall quantity ganeratw)is true. <br /> Generato> :a's Primedffyped Name Sgnalu `bnth Day Year <br /> � !� v/ <br /> a 16.InlernabonatStipnents <br /> 1— C Import to US. C�Export from U S, Pad of eniryfexit ...... <br /> ? Transporter slgne a(tor e.,pjds cnlyi: Dale le ying US.: <br /> w <br /> 17.T Acknawiedgmenl of Recegl al .ateriaals <br /> it Tran por 1 Pr' d7T) me Sign u Month Day Year <br /> 0 <br /> 0- <br /> :4Zz4l O- <br /> Z Transperler2'rin dI va(ure Month Day Year <br /> Q <br /> oc <br /> r— <br /> I&D screpancy <br /> 18a.Discrepancy Indicefion Space r , <br /> �'.Ouanlily U Type �Residue �Partial Re.ectix Li FLA Rejection <br /> _ IAWdesl Reh.-relxe Number: <br /> 181b.Alternate Facility(o•Generates) LLS.FPA ID Number <br /> J <br /> U <br /> W Faafi:Js Phore: <br /> w 183 Signature of Alternate Facility(of Generator) MatRr Day Yea <br /> U319.Hazardous Waste Report Management f lhod Codes(i.e.,ccdes for ha:adocs waste treatment•disposal and recycling systems) <br /> 0 1. 2. 4. <br /> 20.Designated Failky Owrer or Operator: n f"jm of recelpi or hazxdous mater al;covered by ttw manifest ce r>riled" tem 18a <br /> Pint :-Tame ,� fAontn Day Year <br /> EPA Form 6700.72(Rev.S-05) Previous a rion;are obsolete. <br /> DESIGNATED FACILITY TC DESTINATION STATE(IF REQUIRE <br />