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L L ! De artment of Toxic Substances Control <br /> Slate,. onmental Protection Agency .SeB Instructions an back of.l}aq� P -Sacramento,California - <br /> Form A 2050-0039{Expires 91-30-99) or, e shaded areas <br /> Please 1, Farm designed for use on elite(I2•pitch)ty._ Manifnst Document No. 2- Page 1 Information in th <br /> 1. Generator's US EPA ID No. is not required by federal law. <br /> UNIFORM HAZARDOUSof 1- <br /> WASTE MANIFEST C AA 9 g Z 0 8 2 5 1 Z rJ <br /> A..State Monifest Document Number 24771857 <br /> 3. Generator's Name and Mailing Address Atte: Pat Gufllerrn <br /> Unified Western Grocers B. Slate Generator's ID <br /> o 5200mSheila Street <br /> •[ 4.� '�6Tr �"e�A O� - C.-State Tionsporter's ID[Reserved.) - <br /> N 6. US EPA ID Number <br /> N 5. Transporter i Company Name - . . - <br /> I, Dr Transporter's Phone 909co <br /> �-�J�7 <br /> 0 <br /> O - - 9. US EPA ID Number E State Tronsporter's It?[Reserved.J <br /> . _ <br /> m 7. Transporter 2 Company Name <br /> F..TraMportef's Phone.- <br /> 'J <br /> J <br /> � . 131. US EPA!D Number .' G. State Facility's ID <br /> U 9, Designated Focifity Name and Site Address <br /> ! U.S. Filter Recovery Services (California). Inc. H• Facility s Phone <br /> 5375 South Boyle Ave. 323.' 277-"A5W <br /> A 9005A '.- T2. Containers 13. Total Id, Unit - <br />, -� Wt/Vol l:Wasio.Wrnber•' <br /> .Q <br /> 1. US DOT Description{including Proper Shipping Nome,Hazard Class,and ID Number). No. 'T e Gluesnniy - <br /> . State <br /> = Non-RCRA, Hazardous Waste Solid 'EPA/Othe t* •° <br /> NONE :` <br /> ?y G SYaie <br /> E <br /> N b• Non-RCRA, Hazardous Waste Liquid <br /> EPA/Och <br /> O e4` <br /> it R M {�3ONIE: <br /> State <br /> N sG <br /> v A <br /> c. - <br /> P TEPA/Other.:,',:- <br /> b <br /> W <br /> w d. <br /> EPA/Other <br /> r— :. <br /> r <br /> U sk <br /> w r M � a-Handl ng Codes for Wastes listed Above h za+fir <br /> 1 Additional Descnphons:foc Matey a1s Listed Above 6 - <br /> o a: ollfdfl/grease/408Wbent Profile <br /> vs: l s1 1 CN71 <br /> 3y <br /> J b. latex parnUvitater �n � y <br /> 7- 15..Specia Handling Instr Ni`n an A i conal Information <br /> o <br /> Gloves & Job Site: 1990 Piccol-i Rd. <br /> . Goggles <br /> Q Stockton', CA. <br /> 1 Z <br /> w Emg. #909-889-5607 <br /> ontent <br /> 1 b. GENERATOR'S CERTIFlCAT10N: I hereby declare that the cc of this constmeneke <br /> !are Fully and accurately described above by proper shipping name and are classified,ped, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applica6le international and nafional government regulations. <br /> if I am a large quanfiy genera4or,I testify That I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to he economically <br /> I a practicable and that I have selected the praUiat I h method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human that <br /> alth <br /> and the environment;OR,if I am a small quantity generator,l have made a good faith effort to minimize my waste generation and select the best waste management method shat is <br /> ce available to me and that Y can afford. <br /> Si°nates Month Da_y Year <br /> y Printed/Typed N ? C <br /> Z <br /> f 17- Trans anter 1 Acknowledgement of Receipt of Materials <br /> 0 <br /> Q Month. Day Year <br /> Signature <br /> a Lu A Print /Typed N me <br /> I LU 5 <br /> w Q 18. Transporter 2 Acknowledgement of Receipt of Materials Month Day Year <br />( Q R Printed/Typed Name Sig ure , <br /> Lu E <br /> I Q R <br /> 19. Nscrepancy Indication Space - <br /> Z F <br /> — A <br /> G <br /> E <br /> f 20- Facili Owneror O erator a ificaiion of recei 1 f a us materials covered 6 this manifest ext t s noted in Hem F9 Month Day <br /> 1 <br /> T Printed/Typed Name Signature <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> f White: TSDF SENDS THIS COPY TO DTS <br /> 'DTSC 8022A[1/991 To: P.O. Box 3000, Sacramento, CA <br /> .:EPA 8700-22 <br />