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NON HAZAFtDOUS WASTE MANIFEST <br />RECEIVED <br />UNIFIED GROCERS JUL 2 8 2014 <br />72581-1 <br />MAN?Fr=Sf*WM9ER <br />1990 PICCOLI ROAD ENVIRONMENTAL HE. <br />ADDRESS DEPARTMENT <br />STOCKTON CA <br />CITY, STATE <br />ZIP <br />QATE <br />209-93 ­ <br />'—/, �C�D <br />PI46p��­1-1990 <br />EPA NUMBER: <br />I CIUANTrry <br />LIST COMPONENTS: % <br />rn <br />A. DIRT <br />E. <br />z <br />M <br />F. <br />EJ <br />M <br />B. --_WATER <br />C. <br />0 <br />H. <br />3) <br />D. <br />PHYSICAL STATE: <br />KLiquid <br />L] Solid <br />WASTE DESCRIPTION: DIRTY WATER <br />GENERATING PROCESS: CLARIFIER WATER <br />SPECIAL INFORMATION: PROFILE#54948 <br />THE GENERATOR CERTIFIES THAT <br />THE WASTE A$ DESrRIF3ED IS 100% 1 x <br />�p <br />NON -HAZARDOUS. <br />TRUCK# <br />fw <br />z <br />P/U DATE: <br />000 <br />0 <br />cans INC. <br />it 230 E. Dumas Street • San Bernardino, CA 92408 <br />(9091889-5607 <br />DRIVE <br />M <br />D.0,H.5. #01 IS P EPA #CAT 080012800 <br />M <br />x <br />K -PURE WATERWORKSSPECIAL <br />� <br />HANDLING <br />OR DISPOSAL METHOD�L <br />-4 <br />U) <br />NAME <br />8910 ROCHESTER AVENUE <br />DA <br />DATA <br />ADDRESS <br />> <br />—IRANCHO CUCAtA0NGA__!:;A_ <br />CITY. 97ATE <br />ZIP <br />PH. <br />P <br />EPA NUMBER: . ...... . ... <br />x , X V �A <br />QUANTITY <br />ALITHOWME) AGENT <br />