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OUS WASTE MANIA T <br /> N4h� AZARD " <br /> '� <br /> Please print or type {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. of <br /> WASTE MANIFEST <br /> CAD 982 508 '251 <br /> 3.Generator's Name and Mailing Address - - <br /> TJaitied. T.1astzra Grocers - Attn:, ?at Cuiller:nety <br /> 5200 Sheila Straet, Colaaercel CA. 90040- <br /> 4.Generator's Phone( 323 264-5200 - <br /> 6 - US EPA ID Number A.State Transporters ID <br /> 5.Transporter 1 Company Name 7� C(�T 080 012' 809 B.Transporter 1 Phone - <br /> Aaz - at Trans <br /> g, US EPA ID Number'. C.State7ransporters ID <br /> 7.Transporter 2 Company Name - - - D.Transporter 2 Phone ' <br /> i0. US EPA 1D Number E.State Facility's ID <br /> 9.Designated Facility Name and Site Address <br /> Ze�edy -Environmental . <br /> 3200 B. 1'r ontera 'Street. F.Facility's Phone 71'c-630-2307 <br /> Ana><eiA, CA. 92305 CAL a00 -200. '500-. . <br /> 12. Containers 13. 14. <br /> Total Unit <br /> 1 i-WASTE DESCRIPTION No. Type Quantity Wt NDI. <br /> a" <br /> �i0tT <br /> iAA•DOTJa ;BASTE LIT3IDS <br /> G b. i <br /> E j <br /> N . <br /> E. <br /> R <br /> A i <br /> . T <br /> g <br /> . - d. - <br /> LLI <br /> aH.Handling Codes for Wastes Listed Above <br /> G.Additional Descriptions for Mater als Listed Ahove <br /> h a.) aon7aazardoas. W3ta' <br /> T-RO ILE #04--AiAT-01-069 <br /> O <br /> a G J <br /> Q 15.Special Handling instructions and Additional Information I .�. t{]Co3Ca St}t i <br /> 1.990 ?iccoli R3. fi <br /> Stocton, .kCA,. -9:5215 1 <br /> I .Z CLOVES & COGGLES I <br /> Z : E.ag. #909-839-5607 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fulSV 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 regilations., . <br /> Dat6 <br /> D <br /> Sna <br /> i ture <br /> Morn Year <br /> fl . <br /> PrintedlT ed Name � _ <br /> Date <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materials - - - Year. <br /> A n8ignat - Month Day <br /> f"/_frJ_- . %Lf/r�`/ Date . <br /> P ement of Receipt of Materials - <br /> n orfs <br /> r2Ac <br /> Acknowledgement P <br /> e.Tra s 9 <br /> 1 P - <br /> r- <br />- 4 Month ..Pay Year. <br /> TPrinted typed Name Signature <br /> H <br /> 19.Discrepancy Indication Space - <br /> ... - -- <br /> A <br /> C20.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 /> Signature ; :Monfh Day Year <br /> T Printed(Typed Name <br /> Y <br /> 800 621-5808 www.LlWmastercom . .. ®PwaTEoa+RECYCLED PAPE <br /> Us0.rd, �e.,row x Rev.3!$5 <br /> F-14 m 2002 LASELMASCEA ( USM SOYM�R nuc <br />