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<br /> Store of Colifornio—Environental Protection Agency See InWuCtlons on bQC�C Of_'__.-�g b• ()apartment of Toxic Substances Contso
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<br /> F.grm-Approved OMB No.2050-0039{Expires 9-30-991 - r Sacramento,California
<br /> Please print o:type, Form designed for use on afire(72-pitch)F` ter.
<br /> {�yfieratos's US EPA ID No. Manifest Document Ny 2. Page 1 Information in the shaded areas
<br /> �WASTE
<br /> RDOUS is not required by Federal law.
<br /> FEST- C 9 8 2 5 0 8 2 5 1 1 9 .9 8 4 °f 1
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<br /> 3. Generators Name and Mailing Address
<br /> Unified Western Grocers - Attn:
<br /> Fat Guillermety ���Yl
<br /> 8brf �4 r • fir' 'F - ,. '`
<br /> 5200.5heila Street, Commerce, . 'CA'. 90040rsfrer iia fvEr� �cPtT
<br /> kn d. Generator's Phone ( 3231 264-5200
<br /> 6- US EPA ID Number � t"eTrplsporteYsRaervsid+jss # ��5 .
<br /> r t 5. Transporter 1 Company Name ra 5t »T��, xf��E
<br /> LOCP
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<br /> Hoz Mat Trans Inc. CAT 01810101.112181
<br /> op 8. US EPA ID Number - "Stateyspa-` 'j D 1( dE`vetf7] �.y ' % v `rir'. ,`
<br /> 7.'Transporter 2 Company Name '
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<br /> 'Witi iAsp'aFl pfi e .as s { -.
<br /> �Q 10.'US EPA ID Number G*iT5}gier�Fg�ds4j�s(tS R^ y c 3 rte }'
<br /> �V 9.'Designated Facility Name and Site Address
<br /> Crosby & Overton
<br /> 1630 W. 17th .Streetncol
<br /> Long Beach CA_ 90813 1 C1 Al DI 918191 91 91
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<br /> � 12. Containers 13. Total � IA. Unit
<br /> •/t 11. US DOT Description)including Proper Shipping Name,Hazard Class,and ID Numbed No. T eQuantify Wt/Vol
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<br /> 3 G AEROSOLS, FLAN1MABI�E, , M P
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<br /> - 15. Special Handling Instructions and Additional Information Job Site: 199.0 Pieeali RC1.
<br /> Z Stockton, CA.' 95215•
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<br /> GLOVES & GOGGLES
<br /> 909--889-5607
<br /> '16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and-ore ctassified,pack6d,
<br /> Vmarked,and labeled,and are in all respects;n proper'condition for transport by highway according io.applicable international and nationo�government'regulations.
<br /> ii If I am a large quantity generator,I certify that 1 have a proggram in place to reduce_the volume and toxicity of waste generated to the degree I have determined to be economic 11
<br /> N practicable and that Rave selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat t6 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 Land that I can afford.
<br /> OPrinfed/Typ Name Signature -Month Day Year
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<br /> LU N17. Transporter 1 Acknawled ement of Receipt of Materials
<br /> A Printed/Typed N e Signature Month Day Year
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<br /> WP O p B. rams orter 2 Acknawled ement of Receipt of Materials
<br /> S Printed/Typed Name rnature Month Day Year
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<br /> (Qj 11. Discrepancy Indication Space
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<br /> 1 20, Facili Owner or ator Certificdir f receipt of bazar s materials c ad'b this manifest ex-- t as noted in Item 19.
<br /> T Printed/Typed N Signature Vin °� Year
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<br /> D NOT WRITE BELO THIS LINE.
<br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30-DAYS.
<br /> DTSC 8022A(1/991 To: P.O. Box 3000, Sacramento, CA 95812
<br /> EPA 8700--22
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