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I t _iii [ tt'r <br /> Department of Toxic Substances onlrot <br /> $tate of California—Environmental Protection Agency <br /> See If15tfUZtlO[l5 041 �4Ck o� 17 ry Sacramento,California <br /> Form proved OMB NO,2050-0039(Expires 9-30-991 <br /> Please not or type. form designed for use on efiro(12-p+tch)y,: 3 Manifest Document No.� 2, Page 1- Information in the shaded.oreas <br /> 1. rola,',-US EPA 10 Na. is not required by Federal law. <br /> WNIFORM HAZARDOUS of <br /> WASTE MANIFEST A D 8121510181 2151.11 41 8L <br /> A. State Man",fest Document Number 237-58867 <br /> 3. Generator's Nome and Mailing Address pat.Guser <br /> llmety <br /> I Unified Western Grocers - Attn: CA. 80040 B. State Generator's ID <br /> a 5200 Sheila Street, arlerce,- <br /> a. Generators Phone 1 323 1 '264-5200 C. 'StateTionsporter's 10[Reserved.] <br /> r 6. US EPA ID Number , <br /> 5. Transporter 1 Company Name - <br /> D. Tronsporier's Phone <br /> CAT 0 8 .0 '0 1 2 8 0 0 909-889-5607 <br /> `� Mat Trans. .Inc. 8. US EPA ID Number E:,`State Transporter's ID[Reserved.l <br /> 7. Transporter 2 Company Name - - <br /> - 'F. 7ranspoitePs Phone <br /> '�a ` E 0. 1S5 EPA ID Number i G_ State Fddliy`s ID <br /> ]� 9. Designated Facility Name and Site Address <br /> ]d D/K EnVlrOnmental H. t6eiliy's Mane <br /> z 3650 E. 26th Street <br /> �a C A L 0 0 0 1 0 5 3 9 4 323 X268-5056 <br /> ]a' Vernon, CA, 90023 12. Containers 13. Total IA. Unit <br /> �4 - No. T e ouantity Wt/Vol 1. Waste Number <br /> 11.`•LIS DOT Description[including Proper Shipping Name,Hazard Class,and ID Numbed Type <br /> - State.352 <br /> iz (diesel/oil/dirt/absorbent) <br /> t- <br /> P D M <br /> EPA/Other <br />` 3 G NON-RCRA HAZARDOUS WASTE SOLID none <br /> State. <br /> o H b- (sulfuric acid/absorbent) 181. <br /> Co <br /> co fPA/Other <br /> ED M P <br /> R NON-RCRA HAZARDOUS WASTE SOLID <br /> A State. <br /> c. <br /> O T <br /> O EPA/CNhe� <br /> R State <br /> w d. <br /> i` Z <br /> z EPA/Other <br /> U q . <br /> LU r 2 ,:- K Handling bodes For Wastes Listed Above <br /> J'Addihonul Descriptions for Materials'Lisied Above <br /> Z a <br /> p a ) :dlest?'1/oil/,di rIabsarbet .= Prollfs` #3y0128 33.E a <br /> W F :) . ',acabsorbent Profae <br /> a sulfuric-: a:. <br /> r <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information job'Site• 1 990'Piccol i Rd. <br /> g Stockton, CA. 952.15 ! <br /> GLOVES & GOGGLES <br /> _ Em #909-889-5607 <br /> 16. GENERATOR'S CERTIFICATION: t hereby declare that the contents of this consignment are fully and accurately described above by proper shipP ing name and are classified,pocked, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nationol government regulations. <br /> If 1 am a largequantify generator,I,cartiFy.lhai I have a.pragram in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br /> practicvble and.that I have selected the protticable method o3 treatment,storage,or disposal currently available to me which minimizes the present and future threat t human health <br /> and the environment;OR,if-I am a small quantity generator,I have made a good faith effort'to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> OMonth Day Year <br /> Pri /Typed Na a Signotu� <br /> d <br /> w <br /> .fa T 17. Transporter T Acknowledgement of Recei t of Materials <br /> oc It Signature Month Day Year <br /> LU A Printed/Typed Nam _ <br /> w <br /> 5 <br /> Pf of Materials <br /> —Z <br /> Op 8. a s otter 2 Acknow ed amen(of Recel - - Month Day Year <br /> T <br /> R Printed/Typed Name Si afore <br /> UA <br /> E i <br /> Q R <br /> V 19. Discrepancy Indication Space s f� 30 <br /> 0 F �!k 'SC-0114 O ti l� <br /> A / r3 Se.Gf+ort+ f3��n _/6a <br /> f , nsA� s/ R <br /> f 20. Facility Owner or O rotor CerEificotion of races t of hazardous material overed b i is manifest exce 1 as noted in Ite <br /> Signature. 615 , ant Day Year <br /> T Printed/Typed typq� lVJ\`` <br /> Y <br /> D.O NOT WRITE BELOW THIS LINE. <br /> White: TSDF SENDS THIS COPY TO ,DTSC WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) To: P.O. Bax 3000, Sacramento, CA 95812 <br /> EPA 8700-22 . <br /> r <br />