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I <br />i <br />L0 <br />P <br />s <br />C <br />P <br />L <br />LL <br />3 <br />t - <br />Q <br />a <br />V <br />Q <br />C <br />U <br />LL2 <br />LL <br />L <br />ac <br />1 <br />LL <br />LL <br />C <br />LL <br />N <br />Q <br />U <br />State of Colifornia—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30.991 See Instructions on back of p Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite f 12•pikh liter. . �?� F 'J c--,--- <br />DO Nth*RITE FLOW THIS LINE. <br />Safeway ii ic. . <br />DISC 8022A 11/991 White: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />UNIFORM HAZARDOUS <br />Genera <br />1 • tor's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />t= 3 1% <br />of�y" <br />is not required by Federal law. <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number . <br />SafeWay INC. <br />23423085 <br />D <br />15900 West Schulte Road Traev rT®453 <br />B. State Generator's 1D <br />A. Generator's Phone f 61Dy it�.i�4�33 Dauq t1e8LTi <br />V <br />5. Transporter 1 Campany Name 6. US EPA ID Number <br />C. State Transporter's ID (Reserved.) <br />0 <br />D. Transporter's Phone <br />9-45-1393 <br />> <br />Ecology Control Inclustrles g Q 3 <br />7. Transporter 2 Company Name S. US EPA ID Number <br />E. State Transporter's ID Reserved. <br />J <br />J <br />L <br />F. Transporter's Phone <br />9. Designated Facility Nome and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />( <br />r <br />83isitiw c`c—i^I�we. Pmwe.w ®ia.a Ti.ww. Cwwtt:- <br />e /•/II,J uGi a Ia.-S vv/ 1J.-01 0 #,6e— 1 aV/1/6r <br />425 iris Ave. <br />H. Fa6liys Phone <br />Inglewood CA 90 - - ,— - - - - - <br />- - - -- = - - - - <br />11. US DOT Description (includingr <br />P Proper Shipping pP g Name, Hozod Class, and ID Number) <br />12, Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />o\I.. ; G?/ sC?a 4.� s �..i....o .OMC�A c..li� <br />State <br />/ av/ •-/ ave Is /us-atr vv•a.e er u.•wr JVN\e <br />/ <br />G <br />(®11,31ctir�J' Weep) <br />A <br />!, <br />� � ^ <br />y <br />� <br />EPA/Other <br />c E <br />N <br />_ _ At . Flammable I iquidn nn s :3 l lNI g� �,�C�l! <br />• <br />State <br />a.ta <br />s E <br />EPA/Other <br />r R <br />Iw�7QtfQitf614,ttffivflCifaj <br />e <br />bolo <br />r A <br />® <br />1 <br />ivini <br />T <br />Ott -KC RA haZarclous waste,liquid <br />State <br />i 0332 <br />EPA/Other <br />F <br />R <br />a(ri i.+crs1 uve$r.r\ <br />%v,C r-1 .. #- f <br />® <br />p� M <br />iJ er4 <br />A ,•� d <br />V Vt <br />` i <br />i <br />i <br />s s _ d• / r• M a <br />Iv�r1-rtL.rvt r�acafuuu:; elqulu <br />StateV12Sle_, <br />t <br />_ _... - - 4. ®e 1 •L WL 9 °�/�. <br />® -Z <br />P <br />EPA/Ofhec <br />_.._ <br />t <br />e <br />! <br />1. Additional Descriptions for Materials Lilted Above <br />K: Handling Codes for Wastes Listed Above <br />j <br />'1 tB.URUTIY,�YY-V:I;V4,VJ;U4 *�aa'a}NTOTItB3}'J'VVl'VV" <br />itu.DTU1' 6VV-06 �55G�FItiilr r9nOS1,� <br />a• �1 Is. <br />4s1• <br />11c.Drurn#8W-07r08,Qq_ . 5f55GfPro111e#g00Z-1 ►- R � <br />a. /' <br />d. �.► <br />•i � n.: ...X -+;a, i n .'sc��ta..,Ft as ci <br />� `% <br />�� <br />15. Special Handling Instructions and Additional Information <br />®.r nf-o 9e^Ar -rote-five aenliiPli5BOF9} a:/�h:la Prtantilinri. Wiminhfa e%r f%himma wr® ani•�rnv'"nin?n ''Q Hour <br />III r.... 4. / ..... ...q,... g+........ . . .. <br />i,. e, .............. <br />emergency beiephone number (800) 32i -5479 (EC:i Despatcher) <br />EC'1 jostYwY,#A-243324 site: groceary �. warehouse EFQd:-'�f, 11a 428 <br />..�....,..,....1 F.. v«.. v.. <br />produce PS <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore Fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br />IF I am o 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 economically <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and the environment; OR, if 1 am a small quantity generator, 1 have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printecl/TypjZtome Signature Month Day Year <br />Transporter 1 Acknowledgement of Receipt of Materials <br />►17. <br />R <br />RPrinted/Typed <br />Name ` �1 ✓ <br />Signature }^ <br />411-1 1 <br />age <br />Month � y Yeor <br />B <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />20. Focili Owner or O rotor Certification of recei t of hazardous materials covere b this manifest ex as noted in Item 19. <br />LYT <br />Pri ed/T ped Nome <br />Signatur <br />Day <br />--M}onth �Year <br />DO Nth*RITE FLOW THIS LINE. <br />Safeway ii ic. . <br />DISC 8022A 11/991 White: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />