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N HAZARDOUS WASTE MAN1r,,-,*T. <br /> Please print or type (Farm designed for use on elite(12 pitch)typewriter) <br /> S s - , <br /> Manifest <br /> NON-HAZARDOU2.Page t <br /> Document No. 5331 of 1 <br /> WASTE MANIFEST CID 982 1.Generators-US EPA ID No.508 25 <br /> 11 3.Generators Name and Mailing Address - <br /> :Inif-Led -des tern Grocers-'fit--i: ?a . Gizil ler ze-Y <br /> 5200 S-iQila Street, Concuierce, 90040 <br /> 4.Generators Phone( 323) 264-5200 _ <br /> 5.Transporter i Company Name 6. - US EPA 14 Number _A.State Transporters ID - <br /> az N'ht Tn 080 012-300 Ei.Transporter I Phone ' 909-889-5607 <br /> 7:Transporter 2 Company Name B. US EPA ID Number C.State Transporter`SID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 1 D. US EPA ID Number E.State Faci131y's 46 4 <br /> .'7V1rf1 mien Val <br /> 2000 EBrllnlaye Lane F.Facility's Phone <br /> Ba'cersfjel Q., 93307 _ cit 100 720 398 65114. <br /> -6 7- ? <br /> 11.WASTE DESCRIPTION - 12. Containers 13. - <br /> Total Unit <br /> No. Type Quantity Wt./Vol.-' <br /> a. <br /> 00 <br /> aJN-"=i-AZ-LRDO JS JNSTE LT .JI!) TS O T 46 - <br /> G b. <br /> E - I <br /> O <br /> W -p d. <br />• N <br /> Q G.Additional Descriptions for Materials Listed Above ._ H.Handling Codes for Wastes Listed Above <br /> N a.)."T3Qt1-`lazarlous water " <br /> ROO I, . ;{#04-T V-01-009 <br />_ Q 15.Special Handling Instructions and Additional Information J01-3.��to: —Stocift6n Facility <br /> 1990 <br /> I'i = 1990 Accoli RJ. <br /> Z ,D17S & <br /> O °vfYE.S Stoc';ton, C"�. 95215 <br /> E Z aTr`I. : 909 .859-5607 <br /> ib <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper conditiog for transport.The materials described on this manifest are not subject to federal hazardous waste regulations.' <br /> Date <br /> Print yped Name Signature- �% - Month Day �YYear <br /> 0 3 ? <br /> 1' 17,Transporter 1 Acknowledgement of Receipt of Materials - - Date <br /> Ff <br /> PSigna r Month Day Year <br /> Nri t ypod Name <br /> 5 � <br /> I� 0 18.Transporter 2 Acknowledgement of Receipt of Materials _ Date <br /> TPrintedrryped Name Signature Month Day Year <br /> E <br /> F1 <br /> 19.Discrepancy Indication Space - - <br /> F <br /> A <br /> C <br /> 1 20.Facility Owner or Operator.Certification of receipt of the waste materials covered by this manifest;except as noted in item 19. <br /> L Date <br /> T Printedlryped Name Signature Month Day Year <br /> • <br /> -F-1402002 LA6EI MASTER®($pp)6215808 www.IabBtmaster,COm tZ pRp ON et Crcteo pMEa .sono xn. Rev.3145 <br /> e.�rx cnwe.0 w. 1 revv.u• <br />