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3.
<br />14, Special Handling Instructions and Additional Information ENVIRONMENTAL HE
<br />`IXO4RTMENT
<br />9b.2) Aerosols Profile# 51192/EPG126
<br />GLOVES & W: GGLBS
<br />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,
<br />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
<br />Exporter, I certifl that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent.
<br />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.
<br />Generatr Offeroes P16e��7ryped Name signature ' Month Day 71E/ . ! J �, .. , a t .. 1 , A1,w, / /4/,.At D. I S` 1/,i I /
<br />::i 16. International Shipments
<br />Import to U.S. Export from U.S. Port of entry/exit:
<br />Z Transporter signature (for exports only): Date leaving U.S.:
<br />IX 17. Transporter Acknowledgment of Receipt of Materials
<br />w � Month Day Year
<br />Transporter 1 Printe /Typed Name
<br />CL
<br />Sig _
<br />ton ' '� N� �:.....,�,,.,, Month Day Year
<br />18. Discrepancy
<br />18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue
<br />(aV. k24CED NA]li'. WAS Kt4tIVEL. IIANULLD ANU STUKED FUN SUBSE(2UpM OFMSiR Reference Numbe
<br />TREA MEYf OR RIEL SE. LkUSBl A UVBtTON. INC OPERATES
<br />18b. Alternate Facilhly'(tik � )TO T uEm. BY INE DEPARTMENT OF TOXIC SUBSTANCE CONTROL TOOMWER
<br />J ;lI 111E ENVtRONMEVTAL PROTECTION AGENCY IN ACCORDANCE WnW 7M PROVIISIIONS OF
<br />t) (F. RESOURCE CONSERVATION AND RECOVERY ACT OF 1916 TOGETMR WnW APPLICABLE
<br />GCRAL AND STATE REGULATIONS. CROSBY A OVERTON HAS ALL OP TFC NECESSARY
<br />Facility's Phone=ZX
<br />W 18c. SignatureAgftM j6$tagility (or Generator)
<br />a
<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />co
<br />wo 1 2. 3.
<br />J -14
<br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a
<br />PrintedlTyped Name1 Signatu
<br />❑ Partial Rejection
<br />U.S. EPA ID Number
<br />4.
<br />❑ Full Rejection
<br />,T4
<br />G --F' t I I
<br />-1-1n►rArin rArrl rrv-rn f`I=1Ip1]ATnR
<br />Please prF or type. (Form designed for use on elite (12 -pitch) typewriter.)
<br />Form Approved. OMB No. 2050.0039
<br />UNIFORM HAZARDOUS 1. Generator ID Number �>
<br />2. Page'1 of 3. Emergency Response Phone
<br />$89.5Ei27
<br />4. Manifest Tracking Number _ ! �(
<br />��+,
<br />WASTE MANIFEST C A 0 9 8 2 5 0 8 5y i
<br />i
<br />U# 3 :^' `
<br />5. Generators Name and Mailing Address
<br />Generator's Site Address (if different than
<br />mailing address)
<br />Unified GrocsrS
<br />Unified Grocers
<br />Attn: Pet GULorTnet q 5200 St''I Ia Street
<br />1990 Piccod. Rd.
<br />Commerce CA 90IJ40
<br />Stocicm CA 96215
<br />Generator's Phone: 3 2 3 2 6 4 - 5 2 0 C
<br />U.S. EPA ID Number
<br />6. Transporter 1 Company Name
<br />r A T 0 80 0 1 2 3 0 0
<br />Diaz Mat Trans, Inc.
<br />7. Transporter 2 Company Name
<br />U.S. EPA ID Number
<br />8. Designated Facility Name and Site Address
<br />U.S. EPA ID Number
<br />Crosby 8 Overton
<br />1839 W. 'I 7th Street
<br />Long Beach CA 90813
<br />C A D 0 2 8 d 0 9 0 1 9
<br />Facility's Phone: 562 432-U45
<br />9a
<br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
<br />10. Containers
<br />11. Total
<br />12. Unit
<br />13. Waste Codes
<br />No.
<br />Type
<br />HM
<br />and Packing Group (if any))
<br />Quantity
<br />Wt.Nol.
<br />JLC v'4Ji1V
<br />'�-^•'
<br />r
<br />fJ
<br />LU
<br />/1Grow7liril
<br />331 I ��2.1
<br />W
<br />JUN`1960,WASTE
<br />3.
<br />14, Special Handling Instructions and Additional Information ENVIRONMENTAL HE
<br />`IXO4RTMENT
<br />9b.2) Aerosols Profile# 51192/EPG126
<br />GLOVES & W: GGLBS
<br />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,
<br />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
<br />Exporter, I certifl that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent.
<br />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.
<br />Generatr Offeroes P16e��7ryped Name signature ' Month Day 71E/ . ! J �, .. , a t .. 1 , A1,w, / /4/,.At D. I S` 1/,i I /
<br />::i 16. International Shipments
<br />Import to U.S. Export from U.S. Port of entry/exit:
<br />Z Transporter signature (for exports only): Date leaving U.S.:
<br />IX 17. Transporter Acknowledgment of Receipt of Materials
<br />w � Month Day Year
<br />Transporter 1 Printe /Typed Name
<br />CL
<br />Sig _
<br />ton ' '� N� �:.....,�,,.,, Month Day Year
<br />18. Discrepancy
<br />18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue
<br />(aV. k24CED NA]li'. WAS Kt4tIVEL. IIANULLD ANU STUKED FUN SUBSE(2UpM OFMSiR Reference Numbe
<br />TREA MEYf OR RIEL SE. LkUSBl A UVBtTON. INC OPERATES
<br />18b. Alternate Facilhly'(tik � )TO T uEm. BY INE DEPARTMENT OF TOXIC SUBSTANCE CONTROL TOOMWER
<br />J ;lI 111E ENVtRONMEVTAL PROTECTION AGENCY IN ACCORDANCE WnW 7M PROVIISIIONS OF
<br />t) (F. RESOURCE CONSERVATION AND RECOVERY ACT OF 1916 TOGETMR WnW APPLICABLE
<br />GCRAL AND STATE REGULATIONS. CROSBY A OVERTON HAS ALL OP TFC NECESSARY
<br />Facility's Phone=ZX
<br />W 18c. SignatureAgftM j6$tagility (or Generator)
<br />a
<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />co
<br />wo 1 2. 3.
<br />J -14
<br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a
<br />PrintedlTyped Name1 Signatu
<br />❑ Partial Rejection
<br />U.S. EPA ID Number
<br />4.
<br />❑ Full Rejection
<br />,T4
<br />G --F' t I I
<br />-1-1n►rArin rArrl rrv-rn f`I=1Ip1]ATnR
<br />
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