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NO..-HAZARDOUS WASTE MANlrcST <br /> Please print or type (Form designed for use on elite(12 pitchy ty)ewriter}- Manifest :1== <br /> NOw1_u HAZARDOUS <br /> 6 DOUS 1.Generator's US EPA ID No. Document No. <br /> Ir H AR <br /> WASTE MANIFEST I CAD. 982 508 251 , <br /> 3.Generator's Name and Mailing Address <br /> Unified Western Grocers - Attn:. 'Pat GuillermetY. <br /> 5200 Sheila Street, Commerce, CA. 90040 <br /> 4,Generator's Phone( 333 - 264--5200 <br /> 6. US EPA ID Number A-State Transporters ID <br /> 5.Transporter 1 Company Name <br /> Hai Mat Trans Inc: -CAT 080 012 8QO B.Transporter l Phone _ <br /> 7.Transporter 2 Company Name - 8. US EPA ID Number C.Slate Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number - E.State Facility's ID <br /> Remedy Environmental <br /> 3200 E. Frontera Street F.Facility's Phone <br /> Anaheim CA. 92806 CAL 000 n m - 14. <br /> . 12. Containers 13. <br /> 11-WASTE DESCRIPTION - Total Unit <br /> _ - No. .Type <br /> Quantity WtNol- <br /> a- <br /> . TT 22 G <br /> NON HAZARMU- <br /> G b. <br /> 1r!?,j tY]e�rt al 9-�Yvices only accept <br /> N Remedy .n` j i ed on thi <br /> E i .,.. <br /> A docu►r►ent coatained the following <br /> T <br /> Tota ns s. <br /> d. <br /> � R <br /> Document#: `E'.�� � •�._: <br /> H.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br />' t <br /> a. ) non-hazardous water <br /> PROFILE #04-=-01-069- <br /> 15.Special <br /> 04-HMT-01--069'15.Special Handling Instructions and Additional to ,rmafion Job Site• Stockton Faci 1`lty <br /> 1990 PiCColi Rd., <br /> GLOVES & GOGGLES Stockton, CA. 95215 <br /> yy <br /> 16 described a <br /> ar <br /> n proper oondition for transpoaa he ma en hereby <br /> decertismibedhat hon tthis manifest tents of rare not subject subject toent are llfede a hazardand ous waste regulations. <br /> all respects <br /> Date <br /> Yea <br /> .PrintedlTyRed Name SI Month f3a - <br /> �] A.i ;AJ <br /> Data <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A <br /> - Print Name <br /> d Signature Mot Day Y <br /> S <br /> p 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> T Printed/Typed Name Signature - Month Day Year <br /> E <br /> R <br /> 19.Discrepancy 1ndlcaGan Space <br /> F <br /> A <br /> 20.Facility owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L Date <br /> ' G . Mon Jy� rear <br /> Y: ypedNam ��n <br />