Laserfiche WebLink
NON-HAZARDOUS WASTE MANIA _ST <br /> Please print or type (Form designed for use on elite(12 pitch).typewdler). _ <br /> ^:µ 1.Generator's US EPA ID No. Manifest 2.Page 1 <br /> NON-HAZARDOUS Document No. <br /> _f<_ WASTE MANIFEST CAD 982 508 251 48161 1 <br /> 3,Generator's Name and Mailing Address - <br /> Unified Western Grocers - Attn; . Pat Guillermety <br /> 5200 Sheila Street, Commerce, CA. 90040 <br /> l�: 4:Generalor'sPhone( 323 ) 264-5200 <br /> tre <br /> 5.Transporter 1 Company Name 6. USE.PA i❑Number A.Slate Transporter's tD <br /> Z -- Soo S.Transporter 1 Phone <br /> '. <br /> 7.Transporter 2 Company Name B. US EPA ID Number C."State Transporters ID <br /> M1; _ D.Transporter 2 Phone <br /> I� <br /> r"`zs 9.Designated Facikity Name and Site Address 10. US EPA ID Number - E.State Facility's ID <br /> R Envi rorn-nenta l <br /> !!.x 320 . ,Fontera Street F.Facility's Phone <br /> Anaheim CA. 92806 2 - - <br /> 11.WASTE DESCRIPTION _ 12. Containers 13. 14. <br /> Total Unit <br /> i+Fo. Type Ouaniity Wt./Val. <br /> V'° <br /> a. j <br /> x <br /> NON-HAZARDOUS WASTE LIQUIDS T T ! G <br /> G b. - - <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> O <br /> 1 R d <br /> •r �.,..� H.Handlin Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above � � 9 <br /> 1 a. ) non-hazardous water <br /> 1 f + <br /> 1 ' <br /> PROFILE.##04—HMT-01—069 <br /> V 15.Special Handling Instructions and Additionat Information - <br /> , ' JOB SITE: Stockton Facility <br /> 1990 Piccoli Rd. <br /> Stockton, CA. 95215 <br /> Gloves & Goggles <br /> "a"'£_'F:i -:�`-r„-^- �ya_-r ":T3 qFF..� <br /> jsem' 's .fit.. '�:4 ..Y i ':r�.:n .�.T,,�Ks`, <br /> -•'-�.''..re'efi Rjii`"� G"i ,.5`- ,�s.-.i'k" �. ; a-_ rr 3r -x'� ,:9 :' s {r^i.^as:s.; '«,�>' "� E :fir '.f,: <br /> +r r. <br /> - 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully andyaccurately'described and are in all respects <br /> in proper condition for transport.The materials doscribed an this manifest are not subject tolederal hazardous waste reguWions- <br /> p <br /> Date <br /> Prinfetyped ame Signature ! Month Dam Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials - Date <br /> R _ ' <br /> (!< Pri10 <br /> n ed am 1;��X <br /> Signature - Month Day Year <br /> IN S <br /> P 1T 2 Akldt f Receipt of Materials - <br /> 0 1B.Transporter cnowegeenop <br /> Date <br /> R . PrinledlTyped Name Signature - Month Day Year <br /> E <br /> Fit <br /> 19.Discrepancy indication Space - <br /> F <br /> A <br /> C. F. <br /> 1 20.Facility Owner or Operator;Certification at receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L Dale <br /> n�e+d/l�Typ,.edyName _ _� �� - 3Ture �-./� - .� / Month _Days Year <br />