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Form Approved.OMS No.2050-0039 Please print or orrn designed for use on elite(12 pitch)typewriter.) 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number UNIFORM DOUS Generator iD Number 0 0025009 7 JJ K WASTE Nl ST 5.GenGenerators Site Address(if different than mailing address) erators nd Mailing Address Untied Western Grocers U.W.G. Attn:Pat GtAnermety,5200 Sheila Street 1990 Picc oli Rd. commerce CA 94040 Stockton CA 95215 Generators Phone: 2 9 8 U.S.EPA ID Number 6.Transporter 1 Compan N e Hoz Mat TransInc. C A 7 4 8 0 0 1 2 8 U.S.EPA ID Number 7.Transporter 2 Company Name 8.Designated Facility Name and Sita Address U.S.EPA tD Number Crosby&Overton.. 1630 W. 17th Street LonBeach CA 90813 Facit s Phone: Ba. 3b.U.S.DOT Descrlpton(Including Proper Shipping Name,Hazard Class,ID Number, 1o.Containers 11,Total 12.Not.Unit 13.Waste Codes HM and Packing Group(it any)) No. Type Quantity Wt. 1. a WASTE Aerosols X 2.1,UN1950 2, C7 3, 4. 14.Spa"-Handling Instructions and Additionalinfonnation 9b.1) aerosols (flammable)-Profile #51192 Gloves Goggles 15. GENERATOR'StOFFEROR'S CERTIFICATION: I hereby declare Mal the contents of this consignment are fully end accurately described above'by the proper shipping naive,and are dassified,packaged, marked and labeleellplacarded,and are in a'I respects in proper condition for transport according to applicable international and national governmental regulations:If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I oer*that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)Is true. SiMonth Day � Year Gena sloffarors P.ted/Typed Name Signs a S e 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entryleml: Transporter signature(for exports only), Data leaving U.S.;,- W 17.TmnsporterAdwoMedgmentofReceiptOlMat6ri8ls Signature Month Day Year F&TmansWp rter 1 Pri tedlTyped Name 0 Al Igna on .Day Year Zrter2PdntedgypedName 16.Disompancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Rasidue ❑Partial Rejection ❑Full Rejection 11FIJA `S Manifest Raference.Number.. U.S.EPA ID Number 18b.Altemate Facili Generator) Facllttls Phone: Month Day Year 18c.Signature ofAltemate Facility(or Generator) a , z N19.Hazardous Waste Report Management Method Codes 0.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU1, 2, 3. 4. 21).Designated Facility Owner or Operate Ce ' ceipi of hazardous materials covered by as noted In Item 18a PnM8drTyped Name Signature IiAonthDa Year EPA Form 8700-22(Rev.3-05) Preeditions are solete. . DESI ATED FACILI TO DESTINATION STATE(IF REQUIRED)