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(Please prim of w e.(Form tleslgrled for use on elite 12- !ch ewrltec) Form Approved.OMB No.2050-0039 <br /> ONIFgkM HAZARDOUS 1.Gerpmla lD Numher 2.Pages of 3.Emergency Response Phone 4.htanlleel Track(ng Number <br /> WASTE MANIFEST• C A D 9 R 2 5 0 R 2 1 012296133 JJK <br /> S..lnamlrla Name and Ma3rgMdas - Gorselaloy89ibAildrmalifJ4tadrlman mplsng adJlass) <br /> Unified Grocers.Inc. Unified Grocers.11x:. <br /> 5200 Slaelfa Street IWO Plrc(A Roact <br /> Comrnerce CA 90040 SIOCIdon CA 95205 <br /> Ganaators Ptrone. 'a n x o `t <br /> 6,Transporter 1 Company Name S.EPA m Number <br /> Ic-VAC Environmental Services C, A R 0 0 0 1 9 3 0 9 1 <br /> T Transponor2 Company Nemo U.S,Ep DRanba <br /> td( Ih L jEGd4N1cKl SJLyTION1 &MN p6043)3L. <br /> g DB51gaaad S Noma aal SdaAddrasa U.S.EPA ID Number <br /> Veofla EES 7ecMlcal Sohrllons <br /> 1704 W First S1. <br /> ]Vasa (.,A 91702 <br /> Fga. on,sDpp, <br /> bJ O <br /> . . Description <br /> Proper Shipping Name,Hazard Cass,ID Numbeh <br /> 10.CoMainem 11.Told 12.Ur1k <br /> HM end Padlirg GYap(gary)) No. Type Quantity WINd 13.Waste Cedes <br /> c 1'UN 1701.Waste Hypochlorite Salto �<-J I I <br /> x '�, Ua. of- 1 /6 6 D002 ,. <br /> 2 ; DrYtTSy x ( cert}arnlasq TUsNh,n . 0 - I5 Us 1a 11I i—--- <br /> — <br /> foo <br /> 3. <br /> 4. <br /> 14.$ppW; dndarg rne6r; a•ana�a nGma4pn <br /> h`-,••+s ',{:.I,. .,l ni ',I ..• P1'p; ''/,� pc ,, y7-. 9 �7`f IS, <br /> C(LC rt' ; 5 q,l Pr F1 le t:t-If rj <br /> 15. OENERATONSIOFF6ROR'9 CERTIFIDATIDN:Ihmehy decl�r�(hal NAwnl; d11dB consgnmenlere Nlly andacc-arelelydescnbed above M the paperahippingname,an, <br /> ere cassiflad parAaged, <br /> maked arM laheadNlecarded,and are in all respects in proper wndlllonfor transport according m appllceb6 Intanaaonel end nefional governmental regdalions.Ilexpod ahgmenl and em Na Primary <br /> Exporter,t wrary 4121 me contents of role consignment wnfarm to the lame d the attached EPAAcknowledgmonl of Consent. <br /> I ca4ry Ilal the waste M1611 do slatoment Identified In 40 CFR 262-27(a)III I am a lugs 1wriltygonomra)or(b)(III son a smai 4wrLlygemlaa)Is M, <br /> (ionemylslo:fayyb Pr' odf yw No1pe ryN�pmp} <br /> r-'k' skifla <br /> � 16.In1emallMa bTgmen'a ' <br /> ZIX <br /> Ll Import to U.S. ❑Export Iran U.S, Podolenlry/eric <br /> Trenspartaslgnalure go,excess;oNy1: -- <br /> Date Madng U.S; <br /> 17.TranspalerAakmMz�nenldlta<dAdMaedas <br /> O Lo Dattel P@NONryp n!Name 2 Slgndao <br /> Io y Day yearTmnsponr2Pdnad7ypal Name J r <br /> P-CfF M�MIA11�rJ Skdnnlural many Daly Yap <br /> } 18.Discrepancy F! <br /> life.Dacromal lndia4on Space ❑ohon4ty ❑T ❑Reslaue ❑Penial Refection <br /> ❑Full ReJec4an <br /> 19b.Agerllare Factiity(or Gleans', Idardad Reference Nuntsor <br /> U.S.EPA ID Nwalar <br /> V <br /> roe. F.els Phone: <br /> ISa.Sgnohea a Ago mota Faabty(a mlpr <br /> Monro Day Year <br /> W1g.Hozadouf " aRnporl 1-13mirOMI Me"Codes(ILS.01 for1hazadoue Waste eeatmanl disposal,and recycling systemsf <br /> 2p. <br /> Pr y Norm <br /> DasgrwelodOv+nerwepoaw,`Corllllw45i drece¢�IofMzaNwT maleray sw¢ntl by,.,atramfmt except as Wed In how lSa <br /> slgnanuo h ear <br /> EPAForm 8700.22(Kw..3.05) plavfous od1I ore obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />