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NON-HAZARD0U5 F1.Generator iD Number 2.Page 1 of 3.Emergency Response Phone 4,Waste Tracking Number <br /> WASTE MANIFEST C A L 0 0 0 2 7 6 6 1 7 1 909-8891-5607 5 7 4 0 1 1 <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Unified Western Grocers Unified Western Grocers <br /> Attn: Pat Guillermety, 5200 Sheila St. 21001 Cabot Blvd. <br /> Commerce CA 90040 Hayward CA 94545 <br /> Generators Phone: 264-5200 U,S.EPA iD Number <br /> 6.Transporter 1 Company Name <br /> er 8 0 0 1 2 8 0 0 <br /> Haz Mat Trans Inc. C A T <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <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 C A L 0 0 0 2 2 0 3 9 8 <br /> Facili 's Phone: -1857 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, ,Containers 11.Total 12.Unit <br /> HM and Packing Group(it any)} No, Type Quantity WtNoi. <br /> cc 1' NON HAZARDOUS WASTE LIQUIDS f <br /> TT G <br /> w <br /> Z z. <br /> u, <br /> c� <br /> 4. <br /> 11 Special Handling Instructions and Additional Information <br /> 9b. 1 ) non hazardous water - Profile # Gloves & Goggles <br /> 07-HMT-100409 <br /> 14.GENERATOR'S CERTIFICATION:I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Generators+Oftero' rinteciTyped arae Signature Month Day Year <br /> G UG z IZ Zlv <br /> ri P- 15.International Shipments ❑Import to p r <br /> ElEx ort from U.S. Port of ant !exit: <br /> z Transporter Signature(for exports onl Da le vlrq U.S.: <br /> cc 16.Transporter Acknowledgment of Receipt of Materials <br /> h Train sportrIPrinte�c0pped�Naame Sign r Month Day Year <br /> a /Y!�/ dry 102 �(�j <br /> aTransporter 2 Printedlryped Nae Signature Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Full <br /> ❑Quantity EJ Type Residue ❑Partial Rejection Rejection <br /> Manifest Reference Number: <br /> 17b.Alternate Facifdy(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rat Facility's Phone: <br /> 17c.Signature of ARemate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> c7 <br /> bL � 0 MSS ASS 4 �J <br /> 18.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 17a <br /> Phritedrryped Name Signature Month Day Ya3� <br /> Iao_Rr f':_n R innaR DESIGNATED FACILITY TO GENERATOR <br />