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N6 14AZARDOUS WASTE MANI QST <br /> Please print or type (Fora designed for use on elite(12 pitch)typewriter) - - s ' - - <br /> 1.Generstois U-9 EPA ID No: Manifest . 2.Page 1 <br /> NON-HAZARDOUS DocumemNo. C�/�4r[p of <br /> WASTE MANIFEST . CAD= 982 508 251 <br /> 3.Generator's Name and Mailing Address <br /> Unified Wastera Grocers -- Atte: .Pat Gaillenuety <br /> 5200 Shaiia Street, Co.amerce, CA.. 93040. <br /> 4.Generators Phone( 32s 264-5200 <br /> 5.Transporter 1 Company Name - - 6. US EPA ID Number A.State Transporters ID ' <br /> '-:iaz .A4i: -Trans, lac. . CAT 080 012 S00 e.Transporter I Ph one 909-889-5507 <br /> 7.Transporter 2 Company Name B. US EPA ID Number C.State Transporters 11). " <br /> D.Transporter 2 Phone <br /> t <br /> 9.Designated Facility Name and Site Address - 10. US EPA ID Number .E.Stale Faci)ity's ID" <br /> i4 Remedy Enviroa:aeatal <br /> 5200 'E. Frontera Street F,Facility's Phone <br /> G <br /> Anaheim, CA' 923 6 CSL 000 200 500 714-530-2307 <br /> 14. <br /> 11.WASTE DESCRIPTION 12. "Gontalners Total' Unit <br /> No: Typo Quantity WtJVol. <br /> a. <br /> YON: UZAMO;US WASTE LIQUIDS <br /> _.' G b. j <br /> E <br /> T. <br /> s <br /> �. <br /> Q" H.Handling Codes for Wastes listed Above s <br /> G.Additional Descriptions for Materials Listed Above <br /> a.) non=hazariou,9 ;water, i <br /> O PROFILE #04—:TAT-01069ac <br /> � <br /> 15.Special Handling Instructions and Additional Informailon -Job Sltl'•'. StOckton.Facility. <br /> _ 1990 Piccol.i.R3. <br /> Z GLOVES & GOGGLES Stockton,.,: CA. 95215 <br /> Z 4 Eca2 #9 <br /> FA <br /> 18.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 this manifest are not subject to federal hazardous waste regulations. <br /> PrintedfT d I ame Signature Month Day Year <br /> I T 17,Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R - <br /> A. Print dllyped Name ],:Slgn ur Month Day Year <br /> - s <br /> p16.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R Signature Month Day' Year <br /> T PrintedlTyped Name g <br /> E <br />�f <br /> q - <br /> F 19.Discrepancy Indication Space - <br /> A <br /> G <br /> 20.Facifity Owner er Operator,Certification of receipt of the waste materials covered by this manifest,except as noted in item-19.- - <br /> L Date-' <br /> TPrintedfTyped Name Signature Month .Day Year <br />!� y <br /> F.-14 0 2002 LABFL�"IASTFA O(800)821-5808 www.labelmaster.com M' EO ON RECYCLED PUEa rn„ce enrx Rev.3/95 <br />