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NOi.-.IAZARDOUS WASTE -MANIA _JT <br /> Please pnrtt or type (Form designed for use an elite(12 pitch)typewriter) <br /> 1.Generator's US EPA ID No. Manifest 2-Page 1 <br /> NON-HAZARDOUS Document No. f J6 <br /> WASTE MANIFEST CAD 982.'508 251 . t/ °' <br /> 3.Generatoes Name and Mailing Address <br /> Unified Western Grocers - Attn: 'Pat Guillermety <br /> 5200 Sheila Street, Commerce, CA. 9004.0 <br /> 4.Generator's Phone( 32)3 . 264--5200 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's 10 <br /> Haz Mat Trans, Inc.' .CAT,080 01.2 800 B.Transporter 1 Phone — — <br /> 7.Transporter 2 Company Nama .. e- US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10, US EPA ID Number E.State Facility's ID <br /> Remedy Environmental <br /> 3200 E: Frontera Street F.Facility's Phone '11440 •Zia <br /> Anaheim, CA. 92806. CAL 000 200 500 � '�� <br /> 11.WASTE DESCRIPTION - 12. Containers 13. 14. <br /> Total -Unit <br /> No. Type Quantity WLNol. <br /> a. � 47 <br /> NON—HAZARDOUS WASTE LIQUIDS <br /> G b. <br /> E <br /> K - <br /> E se..z: ,s'�c:;r-hazard'rr�� crrtetrfeze{sided r-eepsJ.�:scr .. <br /> R o, ofattriai.Water or ERM shipped,on t ocaxnent <br /> A contained theiouGWIng: <br /> Tatatfif <br /> R d. q 011f A4 <br /> n <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> n a.) non_hazardous water <br /> 7 <br /> ROFILE #04-HMT-01--069 <br /> Twc* <br /> 15.Special Handling Instructions and Additional Information ,Jot] Site: Stockton -Facility <br /> _ 1.990 Piccoli Rd. <br /> z GLOVES & GOGGLES Stockton, CA. -95215 <br /> z Em #909-889-5607 <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 condition for transport.The materials described on this manifest are not subject to federal hazardous waste regulations: ,'.- j <br /> Data- <br /> 0 <br /> ate ..r�. <br /> YPI <br /> PrintedW Name Signatur ► p YI ,deAaa <br /> // I <br /> T 17.Transporter 1 Acknowiedgement of Rooei t o1 Materials Date <br /> A <br /> Sign r D. Yea <br /> i <br /> P <br /> d 18.Transporter 2 Ackrf6wledgement of Receipt of Materials - - Date <br /> R <br /> T Pdntedlryped Name Signature Month :Day Year <br /> E <br /> R <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 /> I Pri tt3dlTyp Name Signature +� IPA <br /> rte" Month Da Year <br /> Yr I 2 <br /> F-14 O 2002 `L ABEL1$L*S FJt*(8W)621-66011 www.lsbelmaster cam D PiiM `�,�e�,r � Rev.3195 <br />