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NO l* ZA <br /> RDOUS:WASTE MAN <br /> Please print or type w� (Form designed tar use'on elite(i2 pitch)typewriter) ManHesi 2.Page 1 <br /> - '.NON'HAZARDO:ST: <br /> i.Generator's US EPA1D No DnclJment No. oTWASTE MANIFECA:? 937_ .509 X51. <br /> 3.Generator's Name and Mailing Address- " <br /> „.: ?Jnifie ' destern grocers - Attn: fat, Quillernety, - <br /> y.; <br /> 52OO :Sheila. Strzflt; .Cotunerc'e; CA. 90040 . <br /> 4.Generators Phone( <br /> 5.Transporter 1'CompanyName US EPA 11)Number A.State Transporter's ID.- <br /> 6. <br /> F3az t�lat -Trans Inc <br /> ; <br /> CAT 0`30 -012 `�� B-7{ansporterl Phone a — ' O <br /> -.I <br /> 7.Transporter 2 Company'Name 8 '- US EPA 14 Number - C.-•State Transportets ID _. <br /> D:Transporter 2 Phone- <br /> C 9.Designated Facility Name an <br /> Site Address ,:Y 10 US EPA ID Number E State Fac lily s ID <br /> Ryinedy Environmeatal' <br /> 32JQ 'ronter Street F.Facility's Phone' <br /> 'A'. .: .' 923`J6 " 'CAL �J00 20C: 5(33 3 - - <br /> Atl3ilB1'91; 14. <br /> _ 13. <br /> ontainere. � ' <br /> 11.WASTE -: Notal.'.... -- t. 1- <br /> No. :'Type 'Quantity' Wt:Nol. <br /> a <br /> tCli� '7ARDOJIS I'�AST, ftwnS <br /> G' b.Lu <br /> - <br /> R <br /> N1. <br /> a i - H Handling Codes for Wastes Casted Above <br /> G:Additional Descriptions.for <br /> Materials C sled Above ' <br /> hazarAus �1at �r <br /> p <br /> VF . . .04 'STT--01 F� <br /> N• 15.Special dandling Instructions and Addteonal Information Ji,b ?� .�' SttlCkt-6i ',Fc3C1lit - <br /> Q 2990icclili R .. <br /> Z.; GLOVES & 60dGLES 5tocktion, A. <br /> O >.,. .. ... 1 <br /> Fri9�19=339-5507 <br /> •16.GENERATOR'S CERTIFICATION,,I hereby;oertify:that the contents ofthis'shipment are fully and:aocurately described-and are,ln aA-respects <br /> L. <br /> irlpfopei cold Pion for transpart.,Tha matenals described on this manifest are not subject to federal hazardous waste.regulallons: <br /> ��- <br /> Print <br /> Name Slgna_tur <br /> . Q .' . -7777 <br /> Date:" <br /> T 17:Transporter 1 Acknowledgement of Recet t-ot Mater1Bls <br /> Gq P" p d.Name Srgna a Mon .D Yea <br /> P Date. <br /> ., :� .-t8:Transporter 2 A wledgement'ot Receipt o1 Matenels <br /> Month- Oa Year., <br /> R' <br /> s <br /> 9 <br /> nature <br /> r <br /> "PrintedlTyped Name _ <br /> E <br /> R <br /> 19.Discrepancylndre ?tin pece <br /> F <br /> A " <br /> C tem 1s::: ' <br /> xce 1 as noted In ... <br /> ales e <br /> thrs man t <br /> ., Bred .•4 <br /> nlscov P waste ata a - <br /> t the was m til+ a . . <br /> n of recel 1 0 - • - - <br /> . --Ifsca4o .. _ <br /> r Cert P <br /> 2.0.Facllrty pwner or Opera[o. <br /> 7 .•P.nntedlTypadName �1 Nature Month aay Year-. <br /> y <br /> f <br /> :O PMER r eX1. <br /> �nx <br /> l Rev 3795 <br /> -- '00"" master COm NTm eR RECYCLE -i.e - - <br /> - ri 0 2602 <br /> lALF1�'{/STER (80(1 <br /> 190$ i <br /> PRIM �I <br /> F 1 1 <br /> - � _ - -.YTi .- atswnsoreEgrlwc-;,;.IE✓l�kNKl <br />