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NON-HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracldng Number <br /> WASTE MANIFEST CAD 982 508 251 1 909--889"-5607 54463-A <br /> 5.Generators Name and Mailing Address Generator's Site Address(il different than mailing address) <br /> Unified Western Grocers Stockton Facility <br /> 5200 Sheila' Street 1990 'Piccoli Rd. <br /> Commerce, CA 90040 ( 323 ) 26.4-5200 " Stockton, CA 95215 <br /> 6.eTransporter 1 nCompany Name <br /> 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 Fadlity 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 000920398 <br /> Facil"es Phone: <br /> 9a. 9b.U.S.DOT Description{includingOu Proper Shipping Name,Hazard Class,ID Number, 10.Containers Total 12.Unit <br /> HM and Packing Group{d any)) -No," Type Ouantfty WtNol. <br /> a NON-HAZARDOUS WASTE LIQUIDS TT G <br /> 2. - E� <br /> s,a <br /> 3. �> <br /> 4. <br /> 13. Special Handling Inshm'dons and Additional Information <br /> 9b.1 ) non-hazardous water Stockton Facility <br /> 1990 Piccoli Rd. <br /> Gloves & Goggles Stockton, CA 9521";5 <br /> 14.GENERATOR'S CERTIFIOATION:1 certity the materials described above on this manifest are not subjet to federal regulatlons for reporting proper disposal of Hazardous-Waste. <br /> GaIV 7 07 <br /> n r1luMerors Medlrypein edpd Naive Signature Month Day Year <br /> Ld�vC/ - <br /> 15.International Shipmerds ❑ ❑ rt from U.S. Port of a /exit Import to U.S. � - <br /> Po <br /> Transportersianature for exports only): Date Ieavin U.S.: <br /> cc 16.Transporter ActmoWedgmant of Receipt of Materials <br /> Tran 1 rinted/Typed Name 51g Month yDay Year Q <br /> , <br /> OCL �7 <br /> CTransporter 2 PrintedlTyped Na* Signature' Mon Day Year <br /> cc <br /> F <br /> 17.Discrepancy' <br /> 17a.Discrepancy Indication Space ❑ouantity ❑Type _ ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> r 17b.Alternate Fatdl'dy(or Generator) U.S.EPA 1D Number <br /> r4i Facility's Phone: <br /> of Alternate Facility or Generator) Month Day Year <br /> 17c.Signature <br />- 9 dy( <br /> ax <br /> 18.Designated Facility Nner or Operator.Certificadon of receipt of hazardous materials covered by the inanifest except as noted in Item 17a r <br /> Printsoyped NameSignatur M Da Year <br /> s `gyp Y_-?- <br /> 169-BLC-0 6 10498 DESIGNATED FACILITYTO GENERATOR <br />