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NG..-HAZARDOUS'WASTE MANN EST <br /> F!ease print or type f Form designed for use on elite(12 pitch)typewriter) Manifest 2.Page 1 <br /> NON-HAZARDOUS 1.Generator's US EPA IC No. "'Document No. <br /> ,Y#,3 46432 <br /> F WASTE MANIFEST CAL 000 276 617 <br /> 3.Generator's Name and Mailing Address <br /> t. UNIFIID WESTERN GROCERS <br /> Rs <br /> 5200 Sheila St. , Commerce, CA. . 90040y <br /> 4.Generator's Phone x323 ) 264-5200 <br /> " S.Transporter 1 Company Name 6. US$PA 10 Number A.State Transporters ID <br /> CAT 080 01 2 800 B.Transperteri Phone gOg_gg _5607 <br /> Haz Mat Trans, .Inc. <br /> g, US EPA 10 Number. C-State Transporter's iD <br /> 7.Transporter 2 Company Name - D.Transporter 2 Phone <br /> US EPA IC Number E.State Facility's ID <br /> 9_Designated Facility Name and Site Address 10. <br /> s- REMEDY <br /> 3200 E. Frontera St. F.Facility's Phone <br /> :y Anahiem, CA. 92806 <br /> CAL 000 200 500 _714-630=2307 <br /> 12. Containers 13. 14' <br /> 11.WASTE DESCRIPTION _ Total Unit <br /> No. Type Quantity Ws.Nol. <br /> j <br /> 1,M <br /> NON-HAZARDOUS WASTE LIQUIDS I t t <br /> G <br /> E <br /> N Remedy Environmental Services only accepts <br /> E <br /> R e. on- azar OUS Waler- WN <br /> A document contained the following: <br /> T <br /> R <br /> R d. Total Units: <br /> `ter <br /> Dgcpment#_ <br /> H.Hand@ng Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above, . <br /> a. ) non-hazardous water. <br /> ais <br /> r <br /> 75.Special-Handling Instructions and Additional Information <br /> �.� JOB SITE: FACILITY <br /> GLOVES & GOGGLES 21001 Cabet Blvd. <br /> Hayward,- CA. 94545 <br /> MA <br /> EMG #909-889-5607 <br /> xi tr.,*a.; vsr^s' t;" % - kt s'• ;�..:t:•."'� � ,�=r� a�*14_, <br /> c- i �:F <br /> z=F^- Mme{`-• a5 �. 7 �xc;.,x 7' 'rcas% rr �r� ,Y< r f v•z ,ru, ,-i `x,,,.:,�, r,, '. i <br /> �•�2�Saf �.�..H,' :�._,,. �`-"i;;-; Gt•.�'•'ti.i.� '��- -`._a s'�G�;,i :?�f�y.,-?' ..,�c.:� Js�„`n:'S' <br /> 16.GENERATOR'S CERTIFICATION:l hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> t ribed on this manifest are not subject to federal hazardous waste regulations.' <br /> in proper condition for transport.The materials desc . <br /> ' - Date <br /> Signature Month Day Year <br /> y- PrintedlTyped Name . <br /> / Cv <br /> Date <br /> R day Year <br /> 17.Transporter t Acknowledgement of Receipt of Matenals _ ^ <br /> .Sid t Month <br /> A Pr' t yped�Nafm�e 1 �7l <br /> S t • G <br /> P Date <br /> O 16.Transporter 2 Ack ledgement of Receipt of Materials , <br /> R Printe,Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> 1 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,e_xcept as noted in item 19. <br /> L Date <br /> T PrinledrTyped Name <br /> Signature- - - Month Day Year <br />