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NON HAZARDOUS WASTEIMANIFEST <br />F FIVED <br />UNIFIED GROCERS 72582-1 <br />NAMFMANIFESTNUMBER <br />1990 PICCOLI ROAD <br />ADDRESS' tNVI NM IALHEALTH <br />2 -, 2 Z - /_3 <br />STOCKTON CA DEPARTMENT <br />CITY, STATE DATE <br />209-931-1990 <br />Pi-iONE <br />EPA NUMBER: 06ANf[TT <br />LIST COMPONENTS: % <br />% <br />M <br />A - ----- DIRT E.- <br />z <br />M <br />B. WATER F <br />C. G. <br />0 <br />PHYSICAL STATE: Ll Liquid El Solid <br />WASTE DESCRIPTION: DIRTY WATER <br />GENERATING PROCESS, CLARIFIER WATER <br />SPECIAL INFORMATION' PROFILE#54943 <br />THE GENERATOR CERTIFIES THAT al <br />fo�_plb_ <br />THE WASTE AS DESCRIBED IS 100% x btj�2 <br />NON,HAZARF)QU5. <br />3-3 <br />> <br />TRUCK # <br />z <br />cn <br />P/U DATE: 7- 7 <br />IV <br />0 <br />Iranswc <br />230 E. Dumas Street ■ San Bernardino, CA 92408 ■ 19091889-5607 <br />Q IVER <br />M <br />01.0-H.S. #0115 N EPA #CAT 080012800 <br />K -PURE WATERWORKSSPECIAL HANDLING <br />s _13 OR DISPOSAL METHOD <br />_z <br />-NAME PATE <br />0 <br />8910 ROCHESTER AVENUE <br />0 <br />RANCHO CUCAMONGA CA 91730 <br />CITY, STATE ZIP <br />F <br />309-47134422 PH.) <br />PHONE <br />EPA NUMBER: <br />AUTHORIZED AGENT <br />QUANTITY <br />