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NON-HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST CAD 982 508 251 1 909-889-5607 55588-A <br /> 5.Generators Name 8nd Mailing Address Generator's Site Address(if different than mairing address) <br /> Unified Western Grocers Stockton'"Facility <br /> 5200 Sheila Street 1990 Piccoli Rd. <br /> Cpmmcerce,- CA 90040 (323) "264-5200 Stockton, CA 95215 <br /> Generator's hone: <br /> B.Transporter.1 Company Name U.S.EPA ID Number <br /> Hoz Mat Trans,lnc. CAT 080 012 800 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> III 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Remedy Environmental <br /> 2000 E. Brundage Lane' <br /> Bakersfield, - CA 93307 (661) 637-1852 CAL 000 220 398 <br /> Facif a Phone: <br /> 9a, 9b.U.S.DOT Dascilpiion(including Proper Shipping Name,Hazard Class,ID Number, i0.Containers 11.Total 12 Unit <br /> HM and Packing Group(H any)) <br /> No. Type Quantity WtNoi. <br /> f e <br /> a Non—Hazardous Waste Liquids TT G/ �� �• <br /> Z2. v <br /> 0 <br /> 3. <br /> - a � <br /> 4A <br /> 13. Special Handling Instructions and Additional Information <br /> 9b:1) non-hazardous water Gloves & Goggles <br /> Profile #07-HITT-10-0409 <br /> 14.GENERATOR'S CERTIFICATION:I certify the materials dewrlbed above on this manifest are not subject to federal regul tions for reportin proper disposal of Hazardous Waste. <br /> Generators) ors PrinteOpo: <br /> Name Signature Month Day Year <br /> " <br /> 15.International Shipments ❑import to U.S. ❑Export =U.S. Port'of entry/exit: <br /> C <br /> = <br /> Transporter Signature fore r{s only): Date leaving U.S,: <br /> s 16.Transporter Acknowledgment of Receipt of Materials <br /> Transport r PrtMedlTyped Name Sign atu Month Day Year <br /> o I Z aT <br /> aTransporter2Pdntedffyped Nkme Signature Month Day Year <br /> 17.Discrepancy <br /> 17a,Discrepancy Indication Space <br /> QuantityType ❑❑ <br /> ❑T Residue El Partial Rejection ❑Full Rejection <br /> Manifest Relerenw-Number <br /> M.Altemaie Facility(or Generator) U.S.EPA ID Number <br /> J <br /> i.1 <br /> FacirVs Phone: <br /> w 170.Signature of Alternate Facility,for Generator) Month Day Year <br /> W <br /> 18.Designated Fadlity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in item 17a <br /> PrintediTyped Name y r� �pa Signature ,- op 1167rt Month Day Year <br /> La 10 <br /> ZZA ze-S -ITO <br />° IWBLC-0 6 10498 DESIGNATED FACILITY TO GENERATOR <br />