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NON H; Z ADOUS WASTIPIMANIFEST <br />UNIFIED GROCERS <br />NAME <br />1990 PICCOLI ROAD <br />MANY E$T NUMBER <br />AgDRC--$$ <br />STOCKTON CA <br />2. 7-z • /_3 <br />CITY, STATE ZIP <br />DATE <br />209-939-1990 <br />PHONE <br />EPA NUMBER: <br />--- v-- <br />LIST COMPONENTS: % <br />LIST <br />% <br />DIRT E. <br />A. <br />M <br />_.._.-_ __.. <br />Z <br />B. WATER n 1=. <br />A <br />_..__. __ _...... <br />I -- <br />b <br />H. <br />F7 <br />M <br />D. - <br />PHYSICAL STATE: CJ Liquid <br />❑ Solid <br />WASTE DESCRIPTION: DIRTY WATER <br />GENERATING PROCESS_ CLARIFIER WATER <br />SPECIAL INFORMATION- PROFILE#54943 <br />SEP 19 2014 <br />THE GENERATOR CERTIFIES THAT <br />THE WASTE AS DESCRIBED IS 100% x <br />VjR0NM- !T!9_ HEALTH <br />NON•HAZAR DOU5. <br />C� <br />33 <br />a <br />fw <br />i TRUCK # <br />Z <br />U) <br />P/U DATE: ' 7- Z ' <br />230 E. Dumas Street ■ San Bernardino, CA 92405 (909) 889-5607 <br />p IVER 'C <br />M <br />D.O_H.S. #01 IS ■ EPA #CAT 080012800 <br />IG -PURE j FATERWOI PGS J,_ <br />HANDLING <br />SR DISPOSAL <br />OR DISPOSAL METHbD <br />-4 <br />_ NAME -- - DATE <br />V> <br />8910 ROCHESTER AVENUE <br />AgDRESS <br />A <br />RANCHO CUCAMONOA CA 99730. _ <br />•r/ <br />0 <br />G1TY, STATE �} ZIP -- <br />X09-4 r.6 -.949z PH. `- <br />PHONE <br />EPA NUMBER: <br />AUTHORIZED AGENT <br />QUANTITY <br />