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NON HAZARDOUS WASTE MANIFEST <br />RECEIVED <br />UNIFIED GROCERS JUL 2 S 2014 <br />NAME <br />lssa PIccO�I �tAp F=NVIRONMENTAL HEALTH <br />angRESS _� <br />ST CKTON CA DEPARTMENT _ <br />CITY. STATE — -- <br />_ 21P <br />PHYSICAL STATE: <br />WASTE DESCRIPTION: DIRTY WATER <br />GENERATING PROCESS: CLARIFIER WATER <br />SPECIAL INFORMATION: PROI=j�.,E r -A <br />THEGENERATOR CERTIFIES THAT <br />THE WASTE AS DESCRIBED IS 100% X <br />NpN-HAZARDOUS- <br />7 Liquid <br />Aw ftr <br />lrc'7nS mr. <br />JF 230 E. Dumas Street ■ San Bernardino, CA 92408 ■ (909) 889-5607 <br />D.O.H.S. #01 15 ■ EPA #CAT 080012800 <br />K -PURE WATERWORKS <br />NAME <br />8910 ROCHESTER AVENUE <br />ADDRESS <br />--RANCHO_cucAAAiS, -OA <br />0 CITY. STATE <br />r' <br />PH6W" W-9492 <br />EPA NUMBER: <br />QUANTITY <br />75081-1 <br />MANIFEST NUMBER <br />DATE <br />auANTITY - <br />Solid <br />TRUCK # 3 <br />P/U DATE: S , /.5. / <br />X <br />SPECIAL HANDLING <br />- OR DISPOSAL METHOD <br />DATE <br />ZIP <br />_ PH. <br />K <br />HORIZEDAGE �y <br />2M931-1990 <br />_ <br />_- _ <br />PMONE <br />-- <br />EPA NUMBER: <br />LIST COMPONENTS: <br />% <br />L7 <br />� <br />A. --- -- DIRT._.._. _ <br />E <br />— <br />M <br />B. WATER- <br />- F. <br />0 <br />C. -- -- -- <br />-� G. <br />M <br />D. <br />— <br />PHYSICAL STATE: <br />WASTE DESCRIPTION: DIRTY WATER <br />GENERATING PROCESS: CLARIFIER WATER <br />SPECIAL INFORMATION: PROI=j�.,E r -A <br />THEGENERATOR CERTIFIES THAT <br />THE WASTE AS DESCRIBED IS 100% X <br />NpN-HAZARDOUS- <br />7 Liquid <br />Aw ftr <br />lrc'7nS mr. <br />JF 230 E. Dumas Street ■ San Bernardino, CA 92408 ■ (909) 889-5607 <br />D.O.H.S. #01 15 ■ EPA #CAT 080012800 <br />K -PURE WATERWORKS <br />NAME <br />8910 ROCHESTER AVENUE <br />ADDRESS <br />--RANCHO_cucAAAiS, -OA <br />0 CITY. STATE <br />r' <br />PH6W" W-9492 <br />EPA NUMBER: <br />QUANTITY <br />75081-1 <br />MANIFEST NUMBER <br />DATE <br />auANTITY - <br />Solid <br />TRUCK # 3 <br />P/U DATE: S , /.5. / <br />X <br />SPECIAL HANDLING <br />- OR DISPOSAL METHOD <br />DATE <br />ZIP <br />_ PH. <br />K <br />HORIZEDAGE �y <br />