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G - NON ri�ARDOUS WASTE MANlf.:S� <br /> Pleas <br /> a print or type,i (Form designed for use on elite(12 Pitch}typewriter) Manifest 2.Page 1 <br /> NON-HAZARDOUS 1.Generators US EPA 10 No. Document No. 9797 of <br /> WASTE MANIFEST CAD 982 508 251 <br /> 3.Generator's Name and Maiiing,Address ' <br /> Unified Western Grocers - Atm: Pat Guillermety <br /> 5200 Sheila Street, Commerce, CA. 90040 <br /> 4.Generator's Phone( 323). 264-5200 - � <br /> 5.Transporter i Company Name 6. US EPA iD Number A.State porterTransPhone <br /> ID- <br /> :Hoz Mat 'lranS Inc. <br /> CAT 080 012 800 B.Transporter 1 Phone <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter}I�ID <br /> .c <br /> D.Transporter 2 Phone <br /> X , <br /> 10. US EPA 10 Number E,State Facility's 10- <br /> 9.Designated Facility Name and Site Address <br /> Remedy Environmental <br /> 3200 E. Frontera -Street F.Facirity'aPhone <br /> .Anaheim CA. 92806 CAL 000 200 500 — — <br /> 12. Containers 13. 14. <br /> 11.WASTE DESCRIPTION - Total Unit <br /> • No. Type - Quantify WiNol. - <br /> a. <br /> NON-HAZARDOUS WASTE LI TDS <br /> G b. <br /> E ggMMy AL SMMM 60k� <br /> N Nw:+ i�e`r waser/essit.i+�reeysMtlble <br /> E 4 a!MW dbit!11111111�Wt <br /> R c. wrt'bKo the <br /> A �/ S <br /> T Twat llrits:, ' T �� <br /> Oyy7(�7 <br /> 1 R d. tlocamExtwll#..dfesrl�: 41 ! f • / <br /> ` <br /> H.Handling Codes far Wastes Listed Above <br /> G.Additional Descriptions for Materials Listed Above <br /> ■ <br /> y a.) non-hazardous water . <br /> t1 <br /> 1 #0 <br /> PROFILE 4-I1M'1'-0 -069 <br /> -�� 4 <br /> C 15.SpeciaEHandling lnstrudionsan dAdditionallnlormation JOb Site: Stockton Facility <br /> . 1990 'Piccoli Rd. <br /> GLOVES &GOGGLES Stockton, CA. 95215 <br /> i m 9 <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are lullY and accurately described and are in all respects <br /> in proper condition for transport.The male; described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printedrryped N Signatu ( Month Day Year <br /> Zt o. <br /> Acknowledgement of Rece <br /> Dato <br /> i� T 17.TransporterlPt of Materials <br /> RSign Month Day Year <br /> nte <br /> A ndfryped Name F <br /> PO 18,Transporter 2 Acknowledgement of Receipt of Materials Date <br /> TPrinledrryped Name Signature Month Day Year <br /> E . <br /> 19.Discrepancy Indication Space <br /> a F <br /> A <br /> C <br /> 20.Facility Owner or Operator,Certification of receipt 01 the waste materials covered by this manifest,except as noted in item 19 - <br /> L Date <br /> 1 I <br /> - T 80%P"yped Name - S a re lh Da Year <br /> F•1402002 �LADEI.AAWER0000)621-mw-wwwr.abWmastaccorn ®PRKrEDoNRECY=DPAPER „e,„n. Rev.3195 <br /> USING SDYWAN W INK" <br />