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ImlON HAZARI]OUS 1.Generaior ID Number 2.Page t of 3.Emergency Response Phone 4.Waste Tracidng Number <br /> WASTE MANIFEST CAD 982 508 251 1 909-889-5607 54885-A <br /> 5.Generators Name and Mailing Address Generators Site Address(A different than mailing address) <br /> Unified Western Grocers Stockton Facility' <br /> 5200 Sheila Street 1990 Piccoli Rd. <br /> CcV%%Cne.e f Ca 90040 - 323-264-5200 Stockton, California 95215 <br /> Genera o s <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> xaz Mat Trans "Inc. CAT 080 012 800 <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 /> F �;Qfield, Ca 93307 (661 ) 637--1852 C=AL 000 220 398 <br /> 9a, 9b.U.S.DOT Description{including Proper Shipping Name,Hazard Class,ID Number; 10.Containers 11,Total 12.Unit <br /> 'No. Type Quantity WtNol. <br /> HM and Paddng Group('rt any)} - <br /> cc <br /> NON-HAZARDOUS WASTE"LI XID8 / TT Gcc <br /> a:° <br /> (� P <br /> Z <br /> . . . <br /> 3, <br /> 4. -' <br /> A <br /> 13. Special Handling IrWructlons and Additional Information <br /> 07-HM7-ti. /o-a fp 9 <br /> 9b.1 )'. non-.hazardous water- Profile , 04 HbIT-6q 969 <br /> 'Gloves & Goggles . <br /> 14.GENERA70R's CERTWICATIOW I certiily the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Generatarsl0fferoes P*rt—edlpad Name Month Day Year <br /> I gyp <br /> 2 <br /> F 15.Intamafional Shipments ❑Import to U.S. Expdn from U.S. 4 Portof entry/exit: <br /> Z T iter Signature tore its only): Date leavin U.S.: <br /> ¢ 16.Transporter AcknovAedgment of Receipt of Materials <br /> LLI <br /> 711 edlTyped N e Sign Month Day Yaw <br /> O O <br /> IL <br /> ZTransporter 2 PdnteVyped NaA Signature Month Day Year <br /> H _ , <br /> 17.Discrepancy <br /> 17a,Discrepancy Indication Space Quantity Type ❑Residue ❑Partlal Rejection ❑Full Rejection <br /> Manlfesl Reference Number <br /> 17b.ARemate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> tai Facility's Phone: <br /> 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> UA <br /> 18.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted In Item ria <br /> PrintedlTyped NameSignature Month Day Year <br /> s aJ <br /> 169-BLC-0 6 10498 ! DESIGNATED FACILITY TO GENERATOR <br />