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Sep 16 09 01:40p Dawn Wickman 715-,- 3485 p.3 <br /> I <br /> ..dre� u� +z-pucnitytawPoer.) RrMApproved.CMB.1;r,,205e-0039 <br /> `' t 2 Page 1 Al 3.Emergency Response Phone d.Manifast Tracking Number <br /> wnSTEMaNiFESTus A55s-s7;-sz 7 1 G B F <br /> 5.Genr:ralor•sNamezrAMaflingAdcrem Ger*rarors Site Address(t different than maihts address; <br /> KRAGEN'rkn_1432 <br /> 3M CHARTER wAY <br /> STOCKTON. CA 95209 <br /> Generalof's Phone: 209-4162-,-� +� <br /> E.T an�acr I Company Mame �' T �0 4 <br /> ��i ami y*i6rly .�a�i►D4" 1111 li?,(j <br /> T.T anspo'ler 2 Company Name U.S EPA Io Vtrtb?r <br /> 3.Designated Facditf Name and Site Add'ess U.S.EPA.D Number <br /> CRI Recyclinq Service Inc WIC]000029761 <br /> 101 Haqen Or •�iIT►VS/47 iCita <br /> Woodville,W 5AO28 9M_24J 2M4 <br /> Fxlity's Phone: <br /> ga, 9b.U.S.ooT Desaiplion iindu3ing Proper ihipping Name,Hazard C)ass,t0 n'umoer, i e.Containers t 1.Tatat 12.Unit <br /> HM and Packinc Group(f any)) 13.Waste Ccdes <br /> No iyoe (wan5ty Nt.Nd. <br /> 1I <br /> o Non-RCRA Hazardo'S Waste Skid DEQ / P 3 <br /> w <br /> z 2. <br /> w }c7 <br /> I <br /> i <br /> 4. <br /> t � <br /> 14,Spedal"Allo <br /> axll Insartclions aidAddifonal Infor aeon <br /> lAtearPrTs7ective Clothing d Eyewear_ 9.1 -OILY ABSCRBEW E-R.G.-9.1 #171 <br /> 15. G-cNERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the cogtents of fhis comigrr-ent ale fulty and amraldy descr bed above by he proper shipping name,and are classified,packaged, <br /> m3tked and labefed+plxarded,and are r.all re3pects in[roper cond?lion fx lanspso according to applicatle international and naoxo:governmental regUalions,if ex=1 shq l and I am the Pdrnar/ <br /> Exporter,I cer'.i`,r that the conterts o(Ihis corsgment conform to he temp of the anad•ed EPA.Ackvxledgment qJFwscnL <br /> I cetiy Thal the waste minimization statement enlfec in 4C CF.4 262.Z7(a)(I I am a I3 ge quar.ly generatnry I Iif I; a small quant tr ye vrabq is ue. <br /> General-doff. fsPtrt Name SMonth Day Year <br /> 1 <br /> J .6.1rk-ralional ipments <br /> Zhnport b U.3. J ExPC(1 firm U.S. P7.1 of ml:.nmk <br /> Transporter sigrature(for exports onty): Oate leaving U S.: <br /> UJ V.Trarsperter.Acatotv:edgmerlolReceiplofhtater <br /> a Transporter 1 PritledrTyped NaneSi a Mon h Oay rear <br /> a rL1 )QA N t <br /> Q limimpoiler2Prinled(lyDedName I Signature Mnth Day Year <br /> tY <br /> F-- <br /> 18.Oscrepancy <br /> 18,i Discrepancy Inflation Space Ouanli( Type ❑P.es, rte <br /> .due ❑Pa .Rejection ❑Ful Rejection <br /> Y Marofest Reference Iumber. <br /> 1ab_ARermle FocB:ty(or Gerterator) U.S.EPA IG Nun-Der <br /> J <br /> U <br /> k FwJlitys Phone: <br /> C3 lEc.Signa:ure of A.Ilernale.adity(of Generator) ldonlh Day Year <br /> Q <br /> Z <br /> En 19.:-lazardrus Waste Repor,Management Mc4ud Cipces(.e.,codes for hwardcus waste trea:men-,drsarsal,and regditg sysic'ns) <br /> W . <br /> 2C.Uasignated Ficilty Owner or Opem:on Ceriica' >i receipl of hazardous materials covered by the m3nde;t llxcepi as nded Illml as r �_ <br /> Prirned!yFed`lameSign v — �/ Month Day "e3' <br /> r LZ l��C i%I q <br /> EPA Form 910.7-22(her.3105) P-evicus editions ark obsolete - <br /> �iw;°i,l'=J=.lC�'� iv i._a•iw'i.�T:fi �?��r� ;i: .:I?���. <br />