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I zZ -- � Ti Z_ -_ <br />NON HAZARDOUS WASTE MANIFEST <br />FLED GROCERS <br />990 PICCOLI ROAD <br />DDRESS <br />OCKTON CA <br />09-934-19910 <br />PHONE <br />EPA NUMBER: <br />JUL 2 8 2014 <br />0 <br />MENTAL HEALTH <br />LIST COMPONENTS: <br />A. DIRT <br />B. WATER n <br />C. <br />D. <br />PHYSICAL STATE: <br />WASTE DESCRIPTION: DIRTY WATER <br />GENERATING PRQCESSEC ARIFIER WATER <br />SPECIAL INFORMATIONPROFILE#54945 <br />THE GENERATOR CERTIFIES THAT <br />THE WASTE AS DESCRIBED IS 100% 1 X <br />NON -HAZARDOUS. <br />69137-1 <br />MANIFEST NUMBER <br />DATE <br />QUANTITY <br />0/b <br />E. I I <br />F. n <br />G. n <br />H. <br />0 Liquid <br />Lino, CA 92412 it (909) 889-5607 <br />D.O.H.S. #0115 m EPA #CAT 080012800 <br />E WATERWORKS <br />TER AVENUE <br />%NCHO CUCAMONGA CA 91730 <br />CITY, STATE <br />19-476-9492 <br />PHONE <br />EPA NUMBER: X <br />HORIZM73ENT <br />QUANTITY <br />TRUCK # <br />3� <br />P/U DATE: 1 - ( Lt - 13 <br />D VER # <br />X, <br />SPECIAL HANDLING <br />OR DISPOSAL METHOD <br />PH. <br />