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Appointment #06757 <br /> NOI.-HAZARDOUS WASTE MANiI �ST 9/26/06 @. 11:0o a.m. <br /> Please print or tvDe (Form designed for use on elite{12 pitch)typewriter) Manifest 2'Page 1 <br /> NON-HAZARDOUS 1.Generator s US EPA ID No. Document No. .5 D�7 :37�� j of / <br /> WASTE MANIFEST CAD 982 5�8 251 <br /> 3.Generator's Name and Maiiing Address <br /> Unified Western Grocers - Attn: Pat Guillermety <br /> 5200 Sheila Street, Commerce, CA. 90040 <br /> 4.Generator's Phone( 323) 264-5200 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number - A.State Transporters ID <br /> Haz Mat Trans, Inc. CAT 080 012. 800 B.Transporter 1 Phone <br /> 7.Transporter 2 Company Name 8. US EPA 1D Number C.State Transporters ID <br /> - D.Transporter 2 Phone <br /> Ad <br /> 9.Designated Facility Name and Site dress -10. - US EPA ID Number E.State Facility's ID <br /> 4 <br /> RemedyEnvironmental - - <br /> 3200 E. Frontera Street F.Facility's Phone <br /> Anaheim, CA. 92806 CAL 000 200 500 714-630-2307 <br /> 12. Containers 13. 14. <br /> 11.WASTE DESCRIPTION Total Unit <br /> No, I Type Quantity W1Nol. <br /> a. <br /> NON-HAZARDOUS WASTE LIQUIDS <br /> G b. <br /> E <br /> N <br /> E i <br /> R c. <br /> : At <br /> T <br /> O <br /> R d. <br /> LU i4IED WW.MON ENTAL SERVICES MY <br /> N _ zardo waterk4claded re"da lc <br /> Q G.Additional Descriptions for Materials Listed Above . 1'fR i es c as es rsted Above <br /> - p , �5. tontiiaed he nE <br /> a.) non-hazardous water 1 r <br /> Total[Fnifs: 50 7 <br /> 0 PROFILE #04-HMT-,0 i-069 pocimen or Man.Himt#:LJ Z, <br /> G <br /> Q 15.Special Handling Instructions and Additional Information ,Jot) Site: Stockton Facility <br /> ill = 1990. Piccal, 'Rd. <br /> Z GLOVES & GOGGLES Stockton, CA. . 95215 <br /> Z EmR. #909-889-5607 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport.The materials described on th s manifest are not subject to federal hazardous waste regulations. <br /> l <br /> Date <br /> PrintedlTyped Name Sig iur Mo Days e <br /> R 17.Transporter 1 Acknowledgement of Receipt c Materials - Date <br /> L4A lP7 yped Name Signat Fe Rn DaIN <br /> Yea <br /> S <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials - Date <br /> TPrinted/Typed Name Signature Month Day Year <br /> R <br /> 19.Discrepancy Indication Space - <br /> F <br />! A <br /> C <br />�. 1 20.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 /> T Print drfyped Name Sie�fSatur Month Day Year <br /> Y L� 46 <br /> F-1402002 LAS 0(800)621+15808 www.labelmaster cOrh Ppn11Ep DNR CLEDP►PER nurrro wrr. - Rev.3195. .. <br />