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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 -251 909-889-5607 54700-A <br /> 5.Generator's Name and Mailing Address Generator's Site Address('d different than mailing address) <br /> Unified Western Grocers Stockton Facility <br /> 5200 SHeila Street 1990 'Piccoli Rd. <br /> Commerce; CA 90040 ( 323) 264-5200 Stockton, . CA 95215 <br /> Generator's Plwne: <br /> 6.Transporter 1 Company Name � U.S.EPA ID Number_ <br /> Haz 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 /> Bakersfield, CA 93307 (661 .) 637-1852. CAL 000 220 398 <br /> Fadi s Phone: <br /> 9a 9b.U.S.DOT Description;nduding Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit <br /> HM and Pandang Group('d any)) No. Type Quantity WLNof. <br /> a Non-Hazardous Waste Liquids TT G <br /> z 2. <br /> uj <br /> 3. <br /> 4. z •. <br /> r <br /> 13. Special handling Instructions and Additional Information <br /> 9.b. 1 ) non-hazardous 'wa-ter Gloves .& Goggles <br /> Profile #07-HMT-10--04,091 <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/Offeror's PrintNameSignature Month D Year <br /> K s . o <br /> 15.International Shipments ❑Import to U'S. ❑Export from U.S. Port of entry/eft <br /> Transporter SI nature for exports onW: Date leavin U.S.:, <br /> 16.Transporter Acknowledgment of Recelpt of Materials <br /> Trams P'ted/TyAl <br /> ,{ e /� Signature <br /> Month Da Year <br /> a /`F J �' 10 <br /> Month Day Year <br /> a Transporter 2 PrintaVyped Note <br /> 6 <br /> Signature <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space ❑Quantity <br /> ❑1y ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> r 17b.Alternate Facility(or Generator) U.S.EPA ID.Number <br /> V <br /> LE Facility's Phone: <br /> 17c.Signature of Altemate Facility(or Generator) Month Day Year <br /> c, , Gtr- �' .; `'�� - .""•.�' '� <br /> 16.Designated Facility Owner or Operator.Cenfftcation of receipt of hazardous materials covered by the manifest except as noted In Item 17a <br /> Printed/Typed Name Signature Month Day Year <br /> 169-BLC-O 6 10496 DESIGNATED FACILITY TO GENERATOR <br />