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NON HAZtRDOUS WASTilMANIFEST <br />P16s jNf\f�W a Fc5_T; <br />UNIFIED GROCERS <br />NAME <br />- <br />MANIFEST NUMBER <br />;! <br />199€3 PICCOLI ROAD <br />jj <br />ADDRESS <br />S10 KTON CA <br />12, <br />CITY, STATE <br />ZIP DATE <br />Tp�!d:l' <br />PHONE <br />EPA NUMBER: <br />2?; <br />QUANTITY <br />t <br />6:... <br />LIST COMPONENTS: <br />d, <br />Pi <br />A. Q1ftT E. <br />I <br />A <br />B <br />F, <br />C. <br />G. <br />(r `, <br />D. F7 <br />H. <br />�p <br />PHYSICAL STATE: <br />❑ <br />Li uid ❑ Solid <br />q ENVIRONMENTAL HEALTH <br />' <br />WASTE DESCRIPTION: DIRTYWATER <br />GENERATING PROCESS:I1.ER WATER <br />SPECIAL INFORMATION: PROEII E*54942 <br />THE GENE=RATOR CERTIFIES THAT <br />i <br />THE WASTE AS DESCRIBED IS 1000h X <br />NON -HAZARDOUS, <br />23 <br />TRUCK # <br />E 2e <br />P/U DATE: <br />rOnS <br />P.O. Box 5129 ■ San Bernardino, CA 92412 • (909) <br />889-5607 <br />DRIVER <br />.1 <br />D.O.H.S. #01 T 5 ■ EPA #CAT 080012800 <br />?;; <br />K -PURE WATERWORKS <br />SPECIAL HANDLING <br />OR DISPOSAL METHOD <br />NAME <br />DATE <br />0910 ROCHESTER AVENUE <br />ADDRESS <br />RANCHO UCANIONGA CA 7 <br />CITY, STATE .ZIP <br />! <br />PH. <br />E <br />EPA NUMBER: <br />X <br />6r <br />�'� 1 <br />Q UANTITY <br />plzEb A�Enrr <br />