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v " US WASTE MA <br /> � T <br /> NO,, 'HAZARDOUS . <br /> Plea, print or lyfpe (Fon*designed for use on elite(12 p 11 1Ma"hestitchy typewriter) 2.Page 1 <br /> 1,Ge"erasora usEPA ID N°' Document No. <br /> NON-HAZARDOUS <br /> WASTE MANIFEST <br /> CAD 982 508 251. ' of <br /> 3.Generators Name and Mailing Address , <br /> Unified Western Grocers -.Attn:', . <br /> Guillermety <br /> 5200 Sheila- Street,. Commerce, CA. 90Q40 <br /> 4.Generators Phone( 32� 264-5200. <br /> g. US EPA ID Number A.State Transporters 1D <br /> 5.Transporter 1 Company Name CAT 080'012 .800 ` . <br /> Haz Mat Trans, 'Inc. . B.Transporter 1 Phone <br /> &. .US ENumber <br /> _PA ID - - C,State Transporters I <br /> 7.Transporter 2 Company Name . <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address - 10. US EPA ID Number E.State Fatuity's ID <br /> Remedy Environmental <br /> 3200 E. Frontera Street F.Facil!Ws 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. Type Quantity WiNoL <br /> NON-HAZARDOUS WASTE LIQUIDS / 17 , <br /> k E b REMEDY pfiNERO��SERVICES Only <br /> N reeydsbie ' <br /> E <br /> A <br /> T :Toms U1sia: <br /> II O <br /> R d. . ' Doeameat otr Malsi�t*: _ <br /> iW <br /> N <br /> Q G.Additlonal Descriplians for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> a.) non-hazardous water <br /> � 7y - <br /> J <br /> PROFILE #04-HMT-01-069 :A <br /> pTJ <br /><< 4 f'y— �" <br /> N15.Special Handling Instructions and Additional Information Jb br. lte: 6tockton Yacility <br /> �_► - 1990 Piccoli Rd'. <br /> ' GLOVES &. GOGGLES Stockton, CA... 95215 <br /> F <br /> Z Emg. #909-889-5607 <br /> - <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 this manifest are not subject to federal hazardous waste regulations. <br /> PrintecUTyped Name Signature - - MonV! Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> Dal <br /> A VIV_51 <br /> Month Day Year <br /> Pd a ped ame Signa a [/h a <br />'r. N <br /> P <br /> O 16.Transporter 2 Acknowledgement of Receipt of Materials - Data - <br /> Printed Typed Name <br /> - -' Signature - Month Day "Year <br /> h EE <br /> R <br /> 19.Discrepancy Indication Space - - - - <br /> ' <br /> A <br /> C <br /> 20.Facility Owner or Operator,Certilicat on of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L Date <br /> T Prinledrryped Name Signatur Month Day Year <br /> Y C__ <br /> 4 F-14 12002 LABELAASTER®(800)821-5808 www.WWrfiaster.com -�patrrrEoonpecvctr:vPWfF�j..,neawrtN - Rev.3195 <br />