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Form Approved OM8 No.2050-0034(Expires 9-30991 See Instructions on back of paiI Department of Toxic Substances Control Please print or type. Form designed for use on elite(12-pitch)type- _ Sacramento,California inerator's US EPA ID No. Manifest Document'I r t 2. Page T Information in the shaded areas UNIFORM HAZARDOUS / is not required by Federal low. WASTE MANIFEST. 1 5 .3 'J".3 ` 1 2 0. 0 5 of � 3. Generators Nome and-Mailing Address ' .. A-_State Manifest Document Number �y- g .AbrL; Pat Gulller` Unified Weemlrn Grocers 5200 Sheila("Street � B. State Generators ID O RG P,40 d.T ene�ralor�sFPhone'{ vGJ �".��00 w $. Transporter 1 Company Name 6. US EPA ID Number G. State Transparter's ID'[Res mD. Transporter's Phone o Haz Mat Trans, Inc mD Number E. State Transporter s ID[Reserved] €r- 7. Transporter 2 Company Name 8. US EPA I - F..Yronsparter:s Phone.,:�,p�>y:.l•,`yA,•,,. e;��`{ K €-��a, :'a €" - t� -•be.• _••?x:��..,,Fia,..`�"awz�`ijt 'S".;:, n "a�. ai`,:sA (a) 10. US EPA ID Number G.:rState•Facilit s 1D';%," 9. Designated Facili Name and Site Address ,,,,°�„ �'•,� °'�, �" �"� °�"•� "`. a Crosby$ Ofertta> Z ? H: Facility s`Phone :': 45s `x { a , a 1630 W. Street .w Long Elaech CA W81 3 - 12. Containers 13. Total 34. Unit Q a _ ' ..- V 11. US DOT Description[including'Proper Shipping Name,Hazard Class,and ID Numbed No Tye Quantity Wt/Val h.Waste`Nurn fser;;";G'r, s' state,, Z . _ WASTE Aerosols F I aiui b 12 >^ 2.1, UN195 0 EPA/Ott 1)o-O'I. G E stale o N b. 331 214' oa0o 7.k.T dt' :�1 7 7 P. EPA/Other v R , 31 r v A State. o T d EPA/Other - R Slate w d. H Z EFA/Other LU V rs.t K. Handling Codes for Wastes Listed Above V'): J. Additional Descriptions for Materials Listed Above p a. {1)aerosols-flammable- Profiler �- b CL #51192 ERG#126 Waste paint-Profile C. d. a i0971 j Z 15. Special Handling Instructions and Additional Information • ' H t7lc75th?S & 'GQCJglg9 Job Sita .1990 Pl.ccol.i R.d. Q Stockt.ozi, CA. ,LErtT.g. #909 -8 9r 560? r F 16= GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,Packed, < marked,and labeled,and are in all respects in proper condition for transport f>y highway according to applicable international and national government regulations. If I am a large gvontity generator,I certify that 1 have a program in:place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically ii practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heat and the environment;OR,if 1 am a small quantity generator,I'have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. O Mantle_ Day Year >_ PA"tedoyped Name =tv j�;� 1 w T 17. Transporter 1 Acknowled emeni of Receipt of Materials } Ur o Day Yea.{/ aC R 1 Signature A Pri d Typed me f j IlW U_ 4 18. Transporter 2 Acknowledgement of Receipt of Materials C? R Printed/T ame gnat r Month_. Day ear LLJ R �+" U 19. Discrepancy Indication Space Z F A C L 20. Facility Owner or Operator Certifiwiion of receipt of hazardous materials covered b this manifest except as noted in Item 19. I T Printed/Typed Nome Signature Month Day Year Y DO NOT WRITE BELOW THIS'LINE. Blue: GENERATOR SENDS THIS COPY 'O DTSC WITHIN 30 DAYS, DTSC 8022A (1/99) To: P.O. Box 400, Sacramento, CA 95812-0400 EPA 8700-22