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FROM (MON).JUL 8 2012 lET:37/ST. 16:32/No. 751 8684 7 01 P 8 <br /> Please print or to,(Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.20,%.0 9 <br /> UNIFORM HAZARd6US_; 2.Page 1 d 3.Emergency Response Phone !.Manifest Tracking Number <br /> WASTE MANIFEST (12'194-09 #59-917-M2 G B F <br /> 5 Generator's Name and Mailing Ad s Generator's Site Address(if diRefent than malting address) <br /> r3TOCKTON SAILI CLUB- <br /> 18LUU EY Ct> _•, <br /> STOC"ON CA SO2,g'T <br /> Generator's Phone: <br /> 6.Transpxxter.1 Compprty N", U.S EPA Iq.Wlmber x. <br /> CRI R : IIG '� <br /> 1.Transporter 2 Company Name' U.S'EPA ID Number.. <br /> 8.Designated Facility Name and Site Address U.S.EPA10 Number <br /> CRI Recvallina Service Inc Wo IM751 <br /> 141 Ha *n Or ii ii <br /> "We, W 54M 8Q0-241-2004 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> 11.Total f2.Unit <br /> HM and Padring Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nd. <br /> 1. <br /> 0cc <br /> Non-RCRA Hazardous Waste Som' DM P 23 <br /> W � 7 <br /> Z 2. <br /> uu <br /> C.7 <br /> THIS COPY IS YOUR <br /> 3. <br /> OF RECYCLING <br /> 4. g .DATE. <br /> 14.Special Handling Instnrctions and Addrbonal Information <br /> Wear Protective Clothing and Eymear. 9A -OILY ABSORBENT ERG--9,1 A 171 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate y described above by the proper shipping name,and are Classified,packaged, <br /> marked and Iabeladrplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the atllched EPA Acknowledgment of Consent. <br /> .I certify that the waste minimization statement identified in 40 CFR 262.27(a)(ff I am a large quantity gene (b) <br /> (if I am a small quantittAgenerator)is Waf <br /> Gene al0lferors Rin Name Signa hon y Year <br /> J 6.InteYotional Shipments <br /> H ❑Import b U.S. El Export from U.S. Port of eMrylerdt <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> LIJ <br /> Transporter 1 Ptinted'Typa-Sed Name Si �r Month <br /> / Day Year <br /> CL <br /> p'l FtT(t- i - <br /> Transporter 2PdntediIypedmme Signature Month Day Year, <br /> it <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space1:1 <br /> Quantity Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Ahemate Facility(or Generator) U.S.EPAID Number <br /> J <br /> U <br /> I �acifitysPhone: <br /> W 18c.Signature o1 Alternate Facility(or Generator) <br /> Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ 1 2. 3. 4. <br /> 20.]esignated Facity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> P ntedrypcedName Signakm -7 _ Month Daya /Year <br /> tj <br /> EPA Form 8700.22(ReV.3-05) Previous itions are obsolete. <br /> 111�114ATED FACILITY TO GENERATOR <br />