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� E <br /> W- AZARPOUS WASTE.MANI% T <br /> NO►. <br /> Please print or type (Fom,designed for use on elite(12 pitch)typewriter) - Manifest 2.Page 1 - <br /> NONr HAZARDOUS i.Generators US EPA ID No. Document No. ZC�I�, <br /> WASTE MANIFEST CAD 982 508 251. �-` li/ °t <br /> 3.Generator's name and Mailing Address <br /> Unified Western Grocers = Attn: Pat Guillermety .. <br /> 5200 Sheila Street, Commerce, CA. 90040 <br /> 4.Generator's Phone( 32$ 264-5200 <br /> 5.Transporter 1 Company Name . 61 US EPA M Number A.State Transporters LD, <br /> Haz Mat Trans, Inc. CAT 080 012 :800 B.Transporter 1 Phone 909-889-5607 <br /> - S. US EPA ID Number C.State Transporters ID <br /> 7.Transporter 2 Company Name <br /> D.Transporter 2 Phone <br /> 10. US EPA ID Number E.State Facility's ID <br /> 9.Designated Facility Name and Site Address <br /> Remedy Environmental <br /> 3200 E. .Frontera Street FF,Facilfty'aP"oneAnaheim, CA. 92806 CAL 000 200 500., 714-630-2307 <br /> 12. Co13. 14_1.WASTE DESCRIPTION - - - Total Unit <br /> No. e Quantity WtNol. <br /> a. <br /> NON—HAZARDOUS WASTE LIQUIDS <br /> Z1 ©d G7. <br /> G b. <br /> E REMEDY ENVIRONMENTAL SERVICES Only <br /> N accepts Non-tiamrdoas water/excluded recyclable <br /> E <br /> R c. contained the following: <br /> Total Units r �1f <br /> R d. F;.-;Er mt•nt or 114anifest <br /> W <br /> Q i H.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above [7 <br /> k N a.) non—hazardous water 7.5��= L 107 u <br /> p PROFILE -#04—HnT--01--069 <br /> Q15-Special Hand ng Instructions and Additional Information .TOb Site• Stockton Facility, <br /> _ 1990' Piccoli Rd. <br /> Z GLOVES &. GOGGLES . Stockton, CA. 95215. <br />!I O # - <br /> Z <br /> 16.GENERATOR'S CERTIFlCA7tRN:1 hereby certify that the contents of this shipment are fully and accurately described and are!nail respects - <br /> in proper condition for transport.The matenals described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> f Signature - - Month Day Year <br /> Printedfiyped Name e - IVA 45 <br /> l Date . <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials. Month pay Year <br /> AP'n ediTypad Name Sign to <br /> h N , z <br /> k s Date <br /> P <br /> 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> I R Month Day Year <br /> T Printedfryped Name Signature <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C 20,Facility owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in Item 19. <br /> Date <br /> - Signatur Month Day Year <br /> T Printe yped Name ' 0 B6 <br /> U flY Q �MIAIIY 1 -ffI111111 111 191 <br /> t ® 84p 621-5808 www.labelmaster.com KTED RECnxE Rev.3195 <br /> f F-1402002 LABEL1"�ASfFR ( ) iwiw:AnvBM11Nn SOYINK _ _ _ <br />