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1 _ TE MA�iV!! _S <br /> NON HAZARDOUS WAS <br /> Y Please print or type (Form designed for use on elite(12 pitch)typewriter) 1, <br /> Manifest _ =2a�;eNON-HAZARDOUS 1.Generatods US EPA ID No. panifest No.WASTE MANIFESTCAD 982 508 251 <br /> 3.Generators Name and Mailing Address <br /> Unified Western Grocers - Attn: Pat Guillermety <br /> 5200 Sheila Street, Cotntnerce, CA. 90040 . <br /> Generator's Phone 2�3 264-5200 <br /> a.G ( 3 <br /> n Name <br /> - 6. US EPA!p Number � A.State Transporters ID <br /> S.transporter 1 Company — <br /> Haz Mat Trans, Inc. CAT 080 012 $OO B.Transpo <br /> rter 1 Phone 909-889 5607 <br /> 6. US EPA ID Number C.State Transporter's ID <br /> 7.Transporter 2 Company Name <br /> 0.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA Ip Number E.State Facility's7D . <br /> Remedy Environmental <br /> .3 200 E. Frontera Street F.FaciltysPhone <br /> Anaheim CA. 92806 CAL 000 '200 500 323-268-505b <br /> 12. Containers - 13. 14. <br /> 11.WASTE DESCRIPTION - - Total unit <br /> No. Type Quantity �� <br /> a. <br /> NON--HAZARDOUS WASTE LIQUIDS <br /> G b. <br /> E <br /> iE <br /> R c. nadirol.warder air ERM saiew go Ab+dbcwm t <br /> A eon"ined the feuewws: . <br /> T <br /> p <br /> d. <br /> I � . DoeucneRt or Maitifeat�le. V <br /> i F G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> - <br /> a. ) �non-hazardous-weter <br /> i <br /> PROFILE #04--IW-01--069 <br /> 3.3 T5 a�_ 0 <br />" = 15.Speaal Handling Instructions andRdditional Information Job Site• Stockton. Facility <br /> 1990 Piccoli Rd.. <br /> GLOVES & GOGGLES Stockton, CA. 95215 <br />� 5m #909-889-5607 <br /> EM <br /> 16.GENERATOR'S CERTIFICATION:!hereby cartity that the convents 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 /> R , <br /> Date <br /> PnntpdiTypad Nam Signalure Month Day Year <br /> K J J O <br /> Dale <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> tSignature Month Day Year <br /> A Printedrryped Name_ J) <br /> IN <br /> P J (f7l <br /> I .. Date <br /> P 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> t9.Disciepancy Indication Space <br /> F <br />' A <br /> C <br /> 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifost,except as noted in item 19. <br /> L Date <br />! t Printed/Typed Name ` Signet r F !--'� Ma h Day Year <br /> Y 266 <br /> . rAA95 rm":IAMI MArM0IWO)621-MM WwW.W)0ImaSter.Q= �' >d%�nrwaFcyaFDPAPS r�a�te�' Rev.3195 - . <br />