Laserfiche WebLink
ARDOUS WASTE MANI�f <br /> _. NOri l�Z _ <br /> typewriter) Manifest 2.Page 1 <br /> Please-print or type (Farm designed for use on elite(12 pitch)1eP - <br /> Generator's US EPA ID No. Document No. of <br /> NON-HAZARDOUS 1.CAD 982- 5082b1 <br /> WASTE ANIFEST <br /> 3.GeneratoP9 Name and Mailing Address <br /> ilnified`W 'stern Grocers - Attn: Pat Guillermety <br /> 5200 Sheila Street, Commerce, CA: 90040 <br /> 4.Generator's Phone{ 323 ) 264-b200 US EPA 0 Number A.State Transportefs ID <br /> 6. <br /> 5.Transporter 1 company Name CAT o8o 012 8U0 B.Transporter l Phone''1 111111111,11,11.1.1. 90!''11111111 I 9-1389-5607 <br /> Haz Mat Trans, Inc. porters <br /> EPA ID Number G State Trans porter's ID <br /> 8. <br /> 7.Transporter 2 Company Name D.Transporter 2 Phone- <br /> ip, US EPA ID Number E:State Facility's ID <br /> 9.Designated Facikity Name and Site Address <br /> Remedy Environmental. F.Facility's Phone <br /> 3200 E. Frontera Street CAL 0UU 2U[J TUU 714-530-2307 <br /> Anaheim, CA. 92306 13- 14. <br /> 12, Containers Total Unit <br /> 11.WASTE DESCRIPTION No. Type Q„a,�y WtNal. <br /> a. <br /> 17 <br /> NON-HAZARDOUS WASTE LIQUIDS <br /> G b• <br /> E REMEDY ENVIRONMENTAL SERVICES O <br /> N ecce - u recyclable <br /> j - E material.Water or ERM shipped on this document <br /> R c, contained the following: <br /> A <br /> T 'Tota <br /> R d- Document or Manifest N: , b <br /> W <br /> QH.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above ` <br /> Cl) a,) non-hazardous water 6 j 4, <br /> 0 ` 6 � <br /> O PR9FLE #04-HMT-01-069 <br /> �. ! ne-=-- <br /> I N 15,Special Handling instructions and Additional Information .Job Site: Stockton Facility <br /> Q I990Piccoli Ttd. <br /> Z <br /> O95215 <br /> GLOVES & GOGGLESStockton, CA. <br /> f - <br /> Z <br /> 18.GENERATOR'S CERTiF1CATiON:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects - <br /> in proper candition for transport.The matenals descritted on his <br /> manifest are not subject to federal hazardous waste regulations. <br />� Date <br /> Sign M r Day Year. <br /> PriniedlTyped Nano <br /> t <br /> _Date <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Month Day <br /> Year <br /> R Signat e <br /> Prints ed Name - <br /> r N /' Xdg.nle, <br /> i s �,�t J r`� Date <br /> 0 18.Transporter 2 Acknowt of Receipt of Materials <br /> R Signature Month Day Year <br /> T PrintedlTyped Name - - - <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> i C <br /> f 2p-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 month p .Year <br /> M <br /> YT t yped Name j <br /> g:;rll� <br /> Rev.3135 <br /> F-1402002 L,AK2$jA 0(8W)621-6808 www.Iabelmd9ler-com �.4+�PRrR1ED ON RECYCLED PAPER ,nMrro.nrn <br /> 1►�TlI �rc�ur:CnrRcw iRr[ C[1 Z <br />