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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS_g:A�L r 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST OIS021840 669-977-6282 GB F 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) STOCKTON SAILING CLUB- 4980 BUCKLEY COVE STOCKTON. CA 995X7 Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number CRI Recycling Service Inc iWIR000029761 7.Transporter 2 Company Name U.S:.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number CRI Reeychnn Service Inc W10"WVII' 7r%4 101 Hagen Or •*��w vvvs. v I li ?ftJJe, WI 540M WO-241-2W4 4 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol, 13.Waste Codes O 1223 tion-RCM Hazardous Waste Solid M -� z 2. W 0 THIS COPY IS YOUR 3. OF RECYCLING 4. g ..6i DATE USpecial Handling Instructions and Additional Information ar Protective Clothing and Eyewear. 9.1 -OILY ABSORBENT E.R.G.-91A #171 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,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 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 identified in 40 CFR 262.27(a)(if I am a large quantity genera �f'r(b)(if I am a small quanti generator)is true, Generators//Offerors P,'nteTr ed Name • Signa a Mont qay Year J 1 6.Inte ational Shipments 11 Import to U.S. Export from U.S. Port of entry/exit: /exit: ❑ p ry Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transspoort�er�I Printed,Typed Name � 1 /J Si r y i Month Day Year Q Transporter 2 Printed/Typed Name SignatureMonth Day Year L H 18.Discrepancy 1 Be.Discrepancy Indication Space ❑ Quantity Type Residue Partial Rejection on Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U - Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1� 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PVted/Typed Name Signature _ Monnth Day Year / EPA Form 8700-22(Re.3-05) Previous Iditions are obsolete. DE NATED FACILITY TO GENERATOR