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$late Id California—Environmental Protection Agency See Initructions On back of page_fi. Department of Toxic Substances Conlrol
<br /> Form Approved OMB No.2050-0039(Expires 9-30-991 - Sacramento,California
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<br /> 1. l atar's US EPA ID No. Manifest Ddcument No. _ 2. Page i Information a the shaded areas
<br /> UNIFORM HAZARDOUS isnot squired 6y Federal law.
<br /> WASTE MANIFEST C AlD g 8 2 5 0181215111 4 6 7 3 2 °f M
<br /> 3. Generator's Name and Mailing AddressA`��Slote�lidntEestRaeu 0. 'vl �'
<br /> Unified Western Grocers - Attn: Pat Guilletmety � � ����� ���. �� .
<br /> 5200 Sheila Street, Commerce, CA. 90040 $rStcteera; 5l�h� � 1
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<br /> A. Generators Phone( 323) 264-5200
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<br /> Company Name
<br /> N 5. Transporter 1 Com n 6. US EPA ID Number
<br /> : ''.�-�*�, �'f _<4
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<br /> (1) y��tarls�orlertis�T+hanrr? �7����
<br /> o Haz .Mat Trans, Inc. CAT 0 8 101_01 1 2 8 0 0y ,� {
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<br /> 7. Trans orter 2 Company Name 8. US EPA 10 Number
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<br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number
<br /> Crosby & Overton
<br /> 1630 W: 17th Street
<br /> Lon Beach CA. 90813 C. A D 0 2 8 4 0 9 0 1 9x
<br /> - - 12. Containers 13. Total 14. Unit' = µ
<br /> _ - ✓-'mss,."�.,a.s�' ,""`
<br /> It. US DOT Description(including Proper Shipping Name,Hazard Class,and l➢islvmber). Nor Tye Quantity Wt/Vol .l ., Ike:uiftfie ..r-„.��:,
<br /> (absorbent/diese ) _.. . . w'.
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<br /> 3 G NON=RCRA HAZARDOUS WASTE SOLID
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<br /> CAD E WASTE AEROSOLS, FTM4ABLE, .2.1 , iJN1950, D M P tE v7f5'th ”,xa
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<br /> W O - WASTE CORROSIVE SOLID, N.O.S , 8, UN1759, P.G. .II .- P
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<br /> Z WASTE HYFOCELORITE SOLUTION, 8, UN1791 , P.G. Il ^
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<br /> Q 15. Special andling Instructions and Additional Informatio � �
<br />. � n,/Q Sob Site: StocktonFacility .
<br /> y , -1DVES & GOGGIES 1990 Piccoli Rd.
<br /> Erng. #909-49-5607
<br /> Stockton, CA. 95215
<br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,
<br /> U - marked,and labeled,and ore in all-respects in proper condition for ironsport by highway according to appliccible international and nationof governmenl regulations.
<br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be ecanomicalfy
<br /> ii practicable and that 1 have selected the ractica6la method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health
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<br /> and the environment;OR,if I am u small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is
<br /> availa6le to me and that I can afford."
<br /> O' Printed/Td Name f Signatu Month Day Year
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<br /> �Z5' T 17. Trans orter 1 Acknowled ement of Receipt of Material's _
<br /> , R Month Day Year
<br /> sL. � Printed/Typed Na e - Signatur
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<br /> si Il 18. Transporter 2 Acknowledgement of Receipt of Materials
<br /> 0 1 Printed/Typed Name Si ature Month Day Year
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<br /> �}- 19. Discrepancy Indication Space -
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<br /> l 20. Facility Owner or O�erator Certification of recei 1 of hazardous materials covered by this manifest a cenoted in Item 19.
<br /> T.' Printed/Typed Nam .. Momh bay Year
<br /> DO NOT WRI-frELO HIS LIN
<br /> DTSC 8022A:(1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS.
<br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812
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