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- yZARDOUS WASTE MANE-�T <br /> NbW HA <br /> r e Form desi ned for use on elite(12 pitch)typewriter) Manifest —^ yy i 2.Page 1 -- <br /> please print or type ( g I.Generator's US EPA ID No. Tr,V bw <br /> NON-HAZARDOUS Document No. of <br /> WASTEMANIFEST <br /> CAD 982 50$ 251 `. <br /> 3.Generator's Name and Mailing Address " - <br /> ocers -'Attn: Pat'Guillermety , <br /> Unified Western Gr <br /> 5200 Sheila Street, Commerce, CA. - 90040 <br /> 4-Generator's Phone( 333 264-5200 - <br /> 6. US EPA 10 Number <br /> 5.Transporter 1 Company Name " A-State Transporters lD — <br /> Haz Mat Trans, Inc. CAT- 080 012 800 .a B:Transporter 1 Phona <br /> g US EPA ID Number C.State Transporter's ID <br /> 7.Transporter 2 Company Name 0.Transporter 2 Phone <br /> 10, US EPA ID Number E.State Facility's ID <br /> 9.Designated Facility Name am!Site Address ' <br /> li Remedy Environmental. F.Facility's Phone <br /> 3200 E. Frontera .Street CAL 000 200 500 714-530-2307 <br /> Anaheim,. CA.. 92806 13. 14- <br /> 12- Containers <br /> Total Unit <br /> 11.WASTE DESCRIPTION _ Quantity Wt.NoL <br /> - No. Type - <br /> a y <br /> NON HAZARDOUS WASTE LIQUIDS <br /> G b.., <br /> 4" aaudia�lalbe <br /> REMEDY <br /> o . <br /> E <br /> R c- contained the following: <br /> A <br /> T Tota!Units: <br /> R d. I)OCument or Manifest#: ��J� <br /> LU �`"f6 <br /> N <br /> F- <br /> r <br /> Q H:Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br /> N a.) non-hazardous water <br /> p❑ 0; �4 - <br /> " PROFILE #04-HMT-01--069 <br /> eLkqN 15.Special Handling Instructions and Addifional information ,lob Site: Stockton Facility <br /> I Q 1990. Piccol.i. -Rd. <br /> = Stockton, CA. 9521.5 <br /> Z GLOVES & GOGGLES <br /> Z 21 Emg. #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 -in proper condition for transport-The materials described on this manifest are not subfect to federal hazardous waste regulations. <br /> Date <br /> Signature f <br /> Month Day Year <br /> Printedf�Ty�Jped Name �fm <br /> ✓{! X1.5 Date <br /> I T 17.Transporter 1 AcknovAedgement of Receipt of Materials - <br /> R Signature _ Month bay Year <br /> A Printedrryped Name <br /> N <br /> E S l Date <br /> f P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials - <br /> R Signature Month Day Year <br /> T PrintedlTyped Name <br /> p - - <br /> R <br /> 19.Discrepancy Indication Space , <br /> F <br /> A <br /> 2o.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 /> k !y y <br /> f Year <br /> 5; QI T Name <br /> Y <br /> Rev.3195 <br /> F-1402002 LA60A5TER0(80a)62i-5608 w^ w,tab81mastercom �/,(��{PRnftED ON MCYCLED PAKR .e.,ro wirx <br /> -M iicnxicnreEANINK <br />