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J DL..,.... :,+ nr hrna (t nrm rlaclnnarl fnr ilea nn alita N %nitrh.. ninawritar 1 Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. _" DFSIGITATED FACILITY TO GENERATOR r..... ,..—_. �. _.... ___.�..__._. UNIFORM HAZARDOUS ___ ' - ,1 1. Genetator ID Number ""' 2 2. Page 1 of 3. Emergency Response Phone --F4—manifest 889 5£'07 Tracking Number � , -� 0 0 7 9 5 3 JJ K WASTE MANIFEST A D 0 x.18 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) Unfled Grr.7cPrs uWed Grocers Attn: Pat Gullers»ty. 5200 Sheila Street 1990 r'lctoli Rd. Commerce CA 90040 Stocltdc+Itt CA 95215 Generators Phone. 3 2 3 2. 6 d- 5 2 0 0 6. Transporter 1 Company Name U.S. EPA ID Number A T 0 8 0 0 1 2 8 0 0 Haz Mat Trans, Inc. iC 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number }emens shy. Inc. 5373 Souh Boyle Ave. Vernon CA W058 C A D 9 9 7 4 3 0 9 9 3 Facility's Phone: 8 rW 2W-77$7 ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No Type HM and Packing Group (if any)) Quantity Wt.Nol. 1N�RCRA Hazardous Waste SoAd 352 1 o (raillabsorberrtjom P i _-� ZLU RA��ste raid '?-2 I �6H-- G 3. FIE E. V, ( I 4. JU 2 8 2014 r � 14. Special Handling Instructions and Additional Information API 9b. 1) oil/Absorbent Prof'.ileff rPfiS! J' DEPARTMENT . Gloves & Goggles 15. GEN ERATOR'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 1 am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the 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. Month Day Year Generators/Off ors Printedrryped ame Signature A J J 1— 16. International Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entrylexit: z Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials i O Transporter 1 Printed yped Name Signature •Month Day Year Z. ranser 2 Printed/Typed Name 7ature Month Day Year p it Q � 1 I- 18. Discrepancy 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. F}- 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U L Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z N19. Hazardo s Wa to port Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) In 1 3. 4. \ \ M\ T inated Ability Owner or Ope ` tor: Certification of receipt, f hazardous materials covered by the manifest except as noted in Ite 16 Month Da Year ped Name Signature Y it r/1,7,� /V/ 1, — 4r, EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. _" DFSIGITATED FACILITY TO GENERATOR