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NON-HAZARDOUS 1.Generator 1D Number 2.Page 1 of 3.Emergency Response Phone. 4.Waste Tracking Number <br /> WASTE MANIFEST C <br /> 5.Generator's Name and Mailing Address Generator's 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 /> i Generator's Phone: U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> Haz Mat Trans, Inc- <br /> 7.Transporter 2 Company Name 11.5.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 /> Facilit es Phone: <br /> 9a. 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit <br /> T <br /> HM and packing Group(if any)) No. 14re Quantity Wt.NoI. <br /> t' NON HAZARDOUS WASTE LIQUIDS ? " <br /> 3150 G.,LU <br /> 2. <br /> k <br /> y y <br /> s- awl <br /> 3 <br /> k <br /> 13. Special Handling instructions and Additional Information <br /> 9b. 1) non hazardous water - Profile °# 707 -HMT=10-0409 <br /> Gloves & Goggles <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 /> G7e tor's/Otfaroes Pn ypeted Name S' tura Month Day Ya <br /> IKe <br /> j 15.International Shipments ❑Import to U.S. ❑Export from U.S. Port of e,tryleudt <br /> 9 Trans iter Si nature for exports only): Date leavi U.S.: <br /> a 16.Transporter Acknowledgment of Receipt of Materials <br /> W - M,7 pav ' Year <br /> Transports 1 Prirded/Typed Name Sign r Z ay 7 <br /> Z Transporter 2 PdnledlTyped Name Signature ' Month Day Year <br /> ccF <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Quantity "' ❑Type ❑Fug Re' <br /> Full❑Partial Rejection Ikon <br /> 'Manifest Reference Number. <br /> 17b.ASemate Facility(or Generator) U.S.EPA ID Number <br /> 7 <br /> LL Facilittls Phone: <br /> w 17c.Signature of Akemate Facility(or Generator) Month Day Year <br /> Lu <br /> 18.Designated Facility Owner or Operator.Certfficafion of receipt of.hazardous materials covered by the manifest except as noted in Item 17a <br /> PdntWyped Name Signature Month Day Year <br /> 169-BLC-0 6 10498 DESIGNATED FACILITY TO GENERATOR <br />