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NOS. AZARDOUS WASTE MANIi I t <br /> Please print or type (Form designed for use on elite(12 pitch)typewriter.) - <br /> 1.Generator's US EPA ID No. , .. Manifest 47398 2.Page 1 <br /> NON-HAZARDOUS _ Document No. of <br /> WASTE MANIFEST (AD91Q2 <br /> 3-Generator's Name and Mailing Address <br /> Unified Western Grocers - Attn: Pat Gtiiillermety <br /> 5200 Sheila Street, Commerce, CA. 90040 <br /> 4-Generator's Phone{ 12)1 264-5200 - <br /> 5.Transporter 1 Company Name 6. US EPA ID Number - A.State Transporter's ID <br /> 74A7 Nlt r- Pon S.Transporter I Phone- <br /> 7.Transporter 2 Company Name 8- US EPA ID Number C.State 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 /> 11.WASTE DESCRIPTION 12..Containers' 13.Total Unit 14 <br /> No. Type Quantity Wt.Nol. <br /> a <br /> NON—HAZARDOUS WASTE LIQUIDS TT G <br /> G`t b. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> 0 d. <br /> U R <br /> yG.Additional Descriptions for Materials Listed Above H.Handling C es for Wastes Listed Above <br /> a. ) non-hazardous water <br /> 7 . <br /> PROFILE #04—Hff-01-069 <br /> _ =: <br /> 15.Special Handling Instructions and Additional Iniormalion Job-Site. Stockton Facility <br /> C 1990 .Piccoli Rd. "A.- <br /> GLOVES <br /> A.GLOVES & GOGGLES Stockton, CA. 95215 <br /> . #909-889-5607.. <br /> 18.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport The materials described on this manifest are,not subject to federal hazardous waste regulations. <br /> Date <br /> Printedrryped Name Sig Month Day Year <br /> PIL OJ <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials _ - Date <br /> R <br /> gig u Month Day Year <br /> S /43 i <br /> 0 18.Transporter 2 Ackno edgemeM of Receipt of Materials' <br /> - <br /> Date <br /> R Printedll-yped Name J 'Signature - - Month Day Year <br /> T <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> A pc)*. <br /> 1 20,Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifesf,except as noted In item M <br /> L Date <br /> T rintedlTyped Name Sig Month Day Year <br /> y <br /> F-1402002 L�dELMASTFA®{800}1321-808 .ww.WW..t..corn PAIMo ON RECYCLED PAPER Rev.W 95 <br /> ® usn+c soreaw[rat <br />