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f <br /> N De arlment of Toxic Substances Control <br /> State a1 Califon environmental Protection Agency See instructions on back of pa�1• p Sacramento,California <br /> Form prove �No.2050-0039 jExpires 9-30-991 <br /> Pleas riot or # Farm designed for use on elite f 12-pitchf f; r•• - <br /> Manifest Document No. 2..Page Z Information in the shaded!areas <br /> 1. tienerator's US'EPA 10 No.' - is not required by Federal low. <br /> a UNIFORM HAZARDOUS of <br /> WASTE MANIFEST CAI} 9 g 2 5 0 8 2 5 1 A a ata hlkgiiffest, um"nk r Fua56er " <br /> 3. ceneralor's Name and Mailing Address -Atlas. Pat Guillermo <br /> Unified Western Grocers <br /> 5200 Sheiia(S`tree# <br /> - <br /> to rTmene`1'n <br /> t\ 32 6. US EPA ID Number aSi°a She €ani er s fD[Reserved) s P <br /> $, Transporter 1 Company Nome <br /> d <br /> O 8. US EPA ID Numb �E�F inie�T�iari��o ass IQ Asserted 3r ha �„` � n '"� � <br /> m 7. Transporter 2 Company Name or - <br />'' � yf`sr"Tea((11sisorter's3P�one�������'�'�• � a, ��,� <br /> Q .10. US EPA ID.Numbar G 5�afe Fa t�rly QIP r � x a <br /> 9. Designated Facility Name and Silo Address <br /> Crosby&Overton <br /> oc1830 W. 17th Street <br /> I- <br /> 12. Containers 13. Total 14. Unit : <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) e :. <br /> No. Tye Guantity <br /> late '. `;i�j5. '•�K��- <br /> G WASTE AEROSOLS, FLAMMABLE 2.1, UN1950 R <br /> M P <br /> o N b. <br /> OD E <br /> m <br /> R . <br /> co O ;, = <br /> x- <br /> LU <br /> 0. s <br /> w er. °t Fa., ra 1q�arr.y °: yi o w5`` ,.nd1i r 'i Wal"'s3l'iled`A6a a .� Fi-. <br /> I toi d lib'asci'©i'sc�i"`tion if6r'l akeFcls'�is a l' Bove _'y x� 'x f M �Ny` c- w•• r_; r <br /> J 'A'd i R. k xs 1 $ z ath �x ? v v v <br /> 'Z a' s7 sK� c ,3Ov <br /> � ': �� z� . �o iAELSPiUFiLE"A92c, $r ,,, ,7r - " '��, �Y�r?'`�w <br /> � <br /> Z 15. Special Handling Instructions and Additional Information <br /> GLOVES & GOGGLES Job site: 1990 Piccoli Rd. f1�3x5 <br /> Z Stockton, CA. , 952.15 <br /> Uj &mg. ##909-889-5607 <br /> X <br /> 1 1 b. GENERATOR'S CERTIFICATION: I hereby declare ihat the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> < marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> IF I am a large quantity generator,I cerliFy that I have a program in place to reduce the volume and toxicity aF waste gsnerared to the degree I have determined to be economically <br /> proctico6le and that I have selected the rracticoble method of treatment,storage,or disposal currently available to me whicfs minimizes the present and future threat to human health <br /> and the environment;OR,if I am a smolt quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> a' available to me,and that I can afford. <br /> O Month Year <br /> Doy <br /> } Printed/Typed Name Signature �- ^ � � Y <br /> Z1fJ/_Wj/ Q <br /> w 8 17, Trans utter 1 Acknowled ement of Recei t of Materials <br /> Signature <br /> Month Day Year <br /> w A Printed/Typed Na e g <br /> R <br /> W 5 <br /> a 18. rens orter 2 Ack owled emeni o Recei t o Materials <br /> R Printed/Typed Name Signa re Month Day Year <br /> O <br /> T <br /> suy E <br /> R <br /> U 19. Discrepancy Indication Space <br /> A <br /> C <br /> 1 <br /> F 20. Foci li Owner or O eratdr tification o ecei t of hazardous m arias b v! is xce pt as noted in item 19. ni� Day Year <br /> T Printed/Typed Name Signature <br /> r �. fir.✓ <br /> DO NOT RITE B HIS <br /> White: TSDF SENDS THIS COPY 'f0 DTSC WITH€N 30 DAYS. <br /> DISC 8022A(1/991 To: P.O. Box 3000, Sa_cramento, CA 95812 <br /> EPA$700-22 <br />