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1 f <br /> Please print or type.(Farm designed for use on elite(12-Pitch)- pewriter.) Form Approved.OMB No.2454 4039 <br /> 1.Generator IDN b r ='mer'1011TV-11200 <br /> 4.Manifest Tracking Number ! <br /> UNIFORM HAZARDOUS `C L982508251, n G <br /> WASTE MANIFEST 0.0 0 6 0-5 05 G B.-F.' <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> _unified Westein Grocers Unified Western Grocers 3 <br /> . 5200 Sheila Street Commerce Ca. 90040 1900 PicWli Road/P.0 Box 60753 <br /> Generators Phone: (323)264-5200 Tera u alAnex,Stockton,Ca. 95215:90660--.., ' <br /> 8.Transporter 1 Company Name U.S.EPA ID Number V <br /> San Joaquin Filter-.Recycling CAL000102751 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number ;Ik <br /> 8.Designated Facility me d Sits addrer U.S.EPA ID Number <br /> <�r jer Y'a _I Ity E <br /> 14287 E. Manning, Parlier. C.A. 93648 <br /> (559) 498-0240 CAL000102751 <br /> Facility s Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total'- 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol. <br /> 1 N.GN - RCRA hazardous Waste., 221. <br /> Liquid (used GiV Nixed.Oil) 1 59 G <br /> LU 2. <br /> LU <br /> 3, <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> NAE,RG# 9B 1 171* Profile #9B 1: Used Oil/Mixed Gil `Appropriate Personal Protective <br /> Equipment <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: 1 hereby declare that the oontents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and$abeledlplacarddd,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(e I am a small quantity generator)is true. <br /> Generator'slOfferors PrinteUtyped Name SignatD71F--""� r- Month Day Year <br /> It.Inlemabonal Shipments <br /> j. ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> z Transporter signature(for exports only): Date leaving U.S.: ' <br /> i <br /> LW 17.TransporterAclv!owledgment of Receipt of Materials. l <br /> 12 Trans rt er 1.PrintedlTyped Name e t Month Day Year <br /> OQ <br /> Z Transporter 2 PrintedfTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Ouantity - ❑Type <br /> ❑.Residue ❑Partial Rejection ❑Full Rejection . <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> . <br /> LL Facility's Phone: 5 <br /> LLj 18c.Signature ofAtternate Facility(or Generator) - Month Ray Year <br /> a <br /> Z <br /> a—] 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> a 1. H141 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous rnaterials,covered by the manifest except as noted in Item 18a <br /> Printedfryped Name Signature Month Day Year ' <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete::: <br /> nF:91GNATFn FACILITY TO GENERATOR STATE!IF REOUIREOI <br />