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0 9 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number (� 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST L0002693 00412156 GBF <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> PICK-N-PLILL NO- <br /> 3927 CLARK DRIVE <br /> Ge1§Tttq ON. CA 95205.5231 <br /> 6.Transporter 1 Company Name 20946? 1192:71 U.S.EPA ID Number <br /> CRI Romfina Service Inc <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CRI Recvcling Service Inc WiR400029761 <br /> 101 Hagen Dr <br /> Fe9Kgq&.Ile, VVI 54028 900-241-2004 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Untt <br /> HM and Packing Group(if any)) --N—.. Type Quantity WINd. 13.Waste Codes <br /> 1. <br /> K <br /> Non-RCRA Hazardous Waste Solid b DM 3Z out P <br /> w <br /> W 2 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Wear Protective Clothing and Eyewear. 9.1 -OILY ABSORBENT E.R.G.-9-1 #171 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of Nis consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemadonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cerfify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that Ne waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators/Offerors PrinledRyped Name Signature Month Day Year <br /> // <br /> 1 .In1e ratio Shtp40 <br /> Z ❑Import to U.S. El Export from U.S. Pon of entrylexiC <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Recelpt of Materials <br /> Transporter 1 Printedrryped Name Si Month Day Year <br /> ra G <br /> QTrandporter2 rinted(Typed Name Signature Month Day Year <br /> K <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Futl Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> w Ise.Signature olAltemate Facility(or Generator) Month Day Year <br /> 2 <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2, 3. 4. <br /> 1 20 Designated Fadlhy Owner or Operator.CBNtication of recelpt of hazardous materials covered by Ne manifest except as reed in Item 16a <br /> dnt yped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br />