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NOWHA7ARDOU5 1•Generator ID Number 2.Page 1 of 3.Emergency Response Plione 4.Waste Tracidng Number <br /> WASTE MANIFEST J . CAD 982 508 251 909-889-5607 54243-A <br /> 5.Generator's Name and Mailing Address Generator's Site Address(It different than mailing address) <br /> Unified Western Grocers-Atte: Pat Guillermety <br /> 5200 Sheila Street, C'.ommerce,- CA 90040 1990 Piccoli Road <br /> (323) 264-5200 Stockton, CA 90040 <br /> Generat es Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number. <br /> Haz Mat Trans, Inc. CAT 080 012-800 <br /> 7.Transporter 2 Comparry Name U.S.EPA ID Number <br /> S.Designated Facility Name and Site Address U,S.EPA ID Number <br /> Remedy Environmental. <br /> 2000 E Brundage Lane <br /> Bakersfield, CA 93307 (551 ) 637-1852 CAL 000 220 398 <br /> FacilkYs Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 1t),Containers11.Total 12.Unit <br /> HM and Packing Group(it any)) No. Type Quantity1. <br /> IM1Nol. <br /> :NON-HAZARDOUS WASTE LIDUIDS TT G <br /> cc <br />'I 2. , <br /> 3 : v <br /> 4• z <br /> ' ta <br /> 13. Special Handling Instructions and Additional Information <br /> 9b.1 ) non-hazardous water <br /> Profile #04-HMT-01-069 Gloves & Goggles <br /> 14.GENERATOR'S CERTIFICATION:I certify to materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> General eror's Print dlTyped Name Signelure - Month Day Year <br /> ri 15.International Shipments <br /> ❑Import to U.S. ❑ExporTfrom U.S. Port of emryl,* <br /> Transporter Signature for exports only): Date lean U.S.: <br />_ Q 16.Transporter Acknowledgment of Receipt of Materials <br /> LTr 4"Typed N Sign Month Day Year <br /> IL OS71VVZ <br /> zTransporter 2 PrintedlTyped N e 5lgnature Month Day Year <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space _❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number, <br /> 17b.Alternate FadRy(or Generator) U.S.EPA 1D Number <br /> ram Facility's Phone: <br /> 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> gxi <br />- r7 -q •rk. - »e' _ ha. "x" "y.„, _•� g ."xc?�8" �.�^�a'.-�",i <br /> LU <br /> 16.Designated Facility Canner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 17a <br /> l: <br /> k PrinteCyped Name Signature Month Day Year <br /> . <br />' 169-BLC-0 6.10498 DESIGNATED FACILITY TO GENERATOR <br />