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iwteofCo;=-nrnia—E•��ronrentalPrctectionAgency See ISIStfUeZtons on back of p, �-b• Department of Toxic Substances Control :0 pproved'OMB No.I050-0039{Expires 9-30.991 - Sacramento,California '3ea print or type. Forrry designed For use on elite(I2-pitch)fyp k. Genera or's�US EPA iD No. Manifest Document No. 2. Page 1 'Information in the'shoded areas UNIFORM HAZARDOUS is not required by federal law. WASTE MANIFEST C A D 918121510 $ 215 1 5 6 0 8 4 of A Stcro Manifest Daca-1 Number 237587,33 3. Generator's Name and Mailing Address ullified Western Grocers _ Attu: Pat Guillermety TT>rTlerce, CA. 90040 B. shifeGenerator'�ID 5200 Shiaila Street, Co 323 264-5200 jf A. Generator's F'ione I I -' - .!! d, U5 EPA ID Number- - C.:',S1nte7randsporter's ID'Reserve ] 5. Transporter 1 Company Name Hoz Mat �ran_s, Inc. CAT 0 8 0 Q 1 12 ,81010 D .7F« arle:';;Pfiane:'gO9Y889-5607' E.�StotoTraris rie�'s ID.Reserved.I - - ` 7. Transporter.2Company'Name 8. US EPA JD Number Pa _ G:`Stdte.Fac_iliil/'s ID l 9. Designated Fcrdity Name and Site Address 10.-US EPA ID Number. - i Drax Erivi-ornental ' 3650 E. 26th Street H71— Fvotlrlys Phone Vertwn CA. 90023 CAL, 0 0 0 1,10]5 3 9 4 r '�i r 323-268 5056 12. Containers -13. Tata! 1 d, Unit - 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. 7y a Quantity WI/vol State- 1 X (absorbent/diesel) -35.2 EPAJOther G NON RCRA HAZARDOUS WASTE SOLID D .M P E �y, b (absorbent/acid) p :EPA/Other, a R WASTE ODItROSIVE SOLID, N.O.S., 8, .UN1759 F °=D0.02 7 A , Stale;f �, 1✓� dmf-•-Gt c3+�.�--�*- u:c>r..i.� L t PIF Li d. 11 u � 'J AddihodalOe;icnphoru fdrNwle�rolskisted Above s a-a; r r' ��'� ti 1•� �Y;r� �`� �r,- r ,�,.;}{�$fmgCodes FarlfYns6es lrsted Above µ i�' •' 1 c [ Y �+-4 'a, a ) abscir3n�Jdiesel Profie�# 5183 " N ' �P d +�� `,j�}fj �--� -�' ' � --;' y a�, i t:f�tA`� �•t�f ��r Y r.� r �� i`�x i r..t sa d k �'y v��. !� .7 +� il A Q �. 3 'AL_ i. s, .sour, - '_`. -r M7 15. Special Handling Instructions and Additional Information Job Site: 1990 Piccoll:.Rd. Stockton, CA. 1 r GLOVES & GDGG1XS Efng. #909--889--5607. 16. GENERATOR'S CERTIFICATION: I hereby declare that the canlenh of this consignment are fully and accurately described above by proper shipping name and are classified,packed, Q marked,and labeled,and ar re in all respects in proper condition For transport by highway according to applicable international and national government regulations. J IF f am a large quantify generator,I certify that I.have a program in place to reduce the volume and toxicity of wtiste generated!o the degree]have determined to be economicallyy I i practicabke and that f hhave selected the eacticable method of treatment,storage,or disposal currently availoble to me which'minimizes the present and future threat to human heoUh V) and the environment;OR,if l am o small quantity generator,I have made a good faith effort 10 minimize my waste generation and select the best waste management method that is available to me and that 1 can-afford. 1 J r'n /Typed N e Si nature Month Day Year Z WQ u t T 17. Trans rter 1 Ackn,wled amen!of Receipt of Materials � R Printed/Typed N me Signature Month ' Day' Year I � M L S ! u- 0 18. Trans rter 2 Acknowlad ement of Recei t of Materials d T Printed/Typed Name S" nature. Month Day. Year w1: � i1 - U 19. Discrepancy Indication Space P 5/V 6 r - s� C7ov / L'/L� at A Cdr i 3 A- s�.0 Qog�o P -� �'�' a�.z. 1 ` L Facili Owner or Operator Certification of receipt of hazardous materials covered 6X this manifest except as noted in Item 19. T Primed/Typed Name Signature tti Day Year Y /.Q�-. .: tib Q C� DO NOT WRITE BELOW THIS LINE. DTSC 8022A 11/991 White: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS. To: P.O. Box 3000, Sacramento, CA 95812 EPA 87022 l' I.