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NON HAZARDOUS WAST1d MANIFEST <br />RECEIVED <br />NIFIED GROCERS <br />WPICCOLI ROAD <br />ADDRESS <br />TOCKTON CA <br />GITY, STATE <br />]9-931-1990 <br />PHONE <br />EPA NUMBER: <br />LIST COMPONENTS: % <br />A DIRT <br />B. WATER <br />C. n <br />D. - <br />PHYSICAL STATE: <br />WASTE DESCRIPTION: <br />DIRTY WATER <br />HENT <br />71663- I <br />MANIFEST NUMBER <br />4F . / �./:e <br />DATE <br />QUANTITY <br />oI0 <br />E. F <br />F. <br />G. <br />H. <br />El Liquid <br />ID Solid <br />GENERATING PROCESS�I p`RfFiER �fITATER <br />SPECIAL INFORMATION PROFILE#54948 <br />THE GENERATOR CERTIFIES THAT <br />THE WASTE AS DESCRIBED IS ICC% X <br />NON -HAZARDOUS. <br />TRUCK # 153 <br />P/U DATE: <br />ransINE. <br />P.O. Box 5129 • San Bernardino, CA 92412 1909) 889-S607 p VER #� <br />D.H.S.A#01 15 ■ EPA #CAT 080012800 1 L� <br />-PURE WATERWORKSSPECIAL HANDLING <br />�� ^ J OR DISPOSAL METHOD <br />NAME DATE <br />910 ROCHESTER AVENUE <br />:�HO CUCAMONGA CA 91730 <br />, STATE ZIP <br />PH. <br />176-9492 <br />EPA NUMBER: <br />AGENT <br />QUANTITY <br />