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NON HAZARDOUS WASTE MANIFEST <br />UNIFIED GROCERS <br />NAME <br />1990 PICC -01-1 ROAD <br />CI <br />EPA NUMBER: <br />RECEIVED <br />ENVIRONMENTAL H <br />LIST COMPONENTS: <br />A. DIRT <br />B. &A -TER I I <br />C. fn <br />D. <br />PHYSICAL STATE: <br />WASTE DESCRIPTION: DIRTY WATER <br />GENERATING PROCESS:IfER WATER <br />SPECIAL INFORMATION: PROEII EA54942 <br />THE GENERATOR CERTIFIES THAT <br />THE WASTE AS DESCRIBED IS 100% X <br />NON -HAZARDOUS, <br />69ti1JO-a <br />MANIFEST NUMBER <br />.�2,/tf <br />DATE <br />QUANTITY <br />E. I II <br />F. JJ <br />G. fn <br />H. n <br />❑ Liquid <br />#w ftr. <br />trans1k r.1111111100"' <br />P.O. Box 5179 ■ San Bernardino, CA 92412 a (909) S89-5607 <br />D.O.H.S. #01 15 ■ EPA ##CAT 080012800 <br />K -PURE WATERWORKS <br />8910 ROCHESTER AVENUE <br />ADDRESS <br />ZIP <br />11 EPA NUMBER: X <br />QUANTITY <br />❑ Solid <br />TRUCK # <br />23 <br />P/U DATE: (0 ' % ?-' 14 <br />DRIVER <br />SPECIAL HANDLING <br />OR DISPOSAL METHOD <br />I: Mm <br />