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NOi, 4q2ARDOUS WASTE MAW--:S <br /> Please print or type i (Form designed for use on elite(12 Pitch)typewriter) _ <br /> 1.Generator' Manifest <br /> s s US EPA ID No. Document No. 2 Page 1 <br /> WASTE MANIFEST CAD 982 508 251 49136 of <br /> 3.Generator's Name and Mailing Address <br /> Unified .Western Grocers - Attn: Pat Guillermety <br /> 5200. Sheila Street, Commerce, CA. 90040 <br /> 4,Generators Phone( 323 264-5200 ' <br /> 5.Transporter 1 Company Name - - 6. US EPA iD Number A.State Transporters ID <br /> Haz Mat Trans, Inc. CAT 080 012 800 B.-TranaporterIPhone 909-889-5607 <br /> 7.Transporter Company Name 8. . US EPA ID Number C.State Transporters ID <br /> D.Transporter 2 Phone <br /> 9.DesignateA Facility Name and Site Address - 10. US EPA ID Number E.State Facilit}rs ID <br /> Remedy,Environmental <br /> 3200 -E. Fronter•a Street r-11"Phone <br /> Anaheim, CA. ' 92806" CAL .0O0 200 500 . 323-268-5 056 <br /> 12. Containers. 13. 14. <br /> T1.WASTE DESCRIPTION Total Unil <br /> l No. Type Quantity W1Nol, <br /> a. <br /> NON-HAZARDOUS WASTE LI IDS <br /> G b. <br /> E <br /> N <br /> E <br /> R �. <br /> A <br /> .T <br /> O <br /> t R d Remedy nviro imental S rvices only accept <br /> Non-Haz -dous water.- ter shipped on thi <br /> k a [3itlfi$ Listed Above <br /> G.Additional Descriptions for Materials Usted Above <br /> a. ) non-hazardous water Total Units: �j��$ <br /> i <br /> PROFILE #04-HMI'--01-069 <br /> Document#: t{Q 13to <br /> 15.Special Handling Instructions and Additional tnformation Job Site- Stockton Facility <br /> 1990 Piccoli Rd. <br /> GLOVES & GOGGLES Stockton, CA.-95215 <br /> Emg. #909-889-5607 . <br /> 16.GENERATOR'S CERTIFtCA17ON:1 hereby certify that the contents of this shipment are lullY and accurately described and are in all respects - 7� 0- <br /> Date 1n f Br Cenclition for tran rt.The materials described on this manifest are not subject to federal hazardous waste regulations.P oP �Printed/Typed Name Signa ti <br /> T 17.Transporter t Acknowledgement of Receipt of Materials <br /> RSfgnatur Mo Day Ye <br /> A <br /> PH t Name <br /> 0P . . (5<� -- 11-4 <br /> 18.Transporter 2 AcknoiFiledgementof Receipt of Materials Date <br /> TPrinted(Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> 20.Facility Owner or Operator,Certification of receipt of the waste materials covered by this manifest,axes as ted in item 19-JJ <br /> - <br /> L Dale <br /> I Si re _ - 1 Month Day Y <br /> dntedlT Name .�7 < - �• i O ` <br /> Y �` L <br /> V. <br /> F44 O 2002 IJ�DEEM/1$TF]L�(800)621-5808 W'MM',W*ma3t9F,0OM PRNTEooN RE O PAPER .rrf war - Rev.3195 <br /> US No SOYBEAN 09 INK. <br />