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NON-HAZARDOUS • 1.Generator ID Number 2.?age 1 c} 3.Emergency Response Phone 4,Waste Trackin�,Nu�mb�,er <br /> WASTE MANIFEST CAD 9 82 5 0 8 2 5 1 1 909-889-5607 �96 - A <br /> 5.Generator's Name and Mailing Address Generatces Site Address(if different than mailing address) <br /> Unified Western Grocers U.W.G. <br /> Attn: Pat Guillermety, 5200 Sheila Street 1990 Piccoli Rd. <br /> Commerce CA 90040 Stockton CA 95215 <br /> Generators Phone: 323 264-5204 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Haz fiat Trans, Inc. C A T 0 8 0 0 1 2 8 0 0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> REMEDY ENVIRONMENTAL <br /> 2000 E. BRUNDAGE LANE <br /> BAKERSFIELD CA 93307 <br /> Faciii 's Phone: 661 637-1852 C A L 0 0 0 2 2 0 3 9 8 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 2.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NON HAZARDOUS WASTE LIQUIDS <br /> ; <br /> W <br /> Z 2, <br /> W <br /> t9 <br /> 4. <br /> 13. Special Handling Instructions and Additional Information <br /> 9b. 1) non hazardous water - Profile #07-HMT-10-0409 <br /> GLOVES & GOGGLES Confirmation #08189 <br /> 14.GENERATOR'S CERTIFICATION:I certify the matenais described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> GeneratorslOttoror's Printed(I"d Nae Signature Month Day Year <br /> MJ ` f�� <br /> 15.international Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylex <br /> Z Transporter Signature for exports on : Date leaving U.S.', <br /> ¢ 16.Transporter Acknowledgment of Receipt of Materials <br /> LU Trans orte 1 PPPrint�edfrryped/Name Signal Month/ Day Year <br /> JA <br /> Z Transporter 2 PdntedrTyped N me Signature Month day Year <br /> 17,Discrepancy <br /> 17a.Discrepancy Indication Space r-�❑ ❑Full Re'Ouantiry Type Residue El Partial Rejection lectien <br /> Manifest Reference Number: <br /> 17b.Alternate Facility(or Generator) <br /> U.S.EPA ID Number <br /> U <br /> ra Facility's Phone: <br /> m 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a I <br /> Z <br /> tA <br /> 16 Designated FaciEity Owner or Operator Certification of receipt of hazardous matenals covered by the manifest except as noted in Item 17a <br /> PnntedlTyped Name � -� Signature �� Month Day Year <br /> � _ d 2� r <br /> ,� o, AAAnr, DESIGNATED FACILITY TO GENERATOR <br />