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Waste <br /> OSystems <br /> No TM <br /> 13ROIM1INING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name Generating Location <br /> Address P 0 Bo% 441' Address 0128 Is Ben Zemin Holt Dr <br /> ljou�t0-1 7F,Nas 2_,!.- 4413 1i10ci,Lo11 1f0, ' I'l <br /> � 1 QS i <br /> Phone No �— Phone No <br /> 139 Waste Code ` 4 0 Containers Type <br /> rurr <br /> Description of Waste Quantit C <br /> Units No T e D - artc <br /> FFF� r- I E C - <br /> B - Bag <br /> — NON HAZARDOL S T -Trucl <br /> SOIL ❑ ❑ P - Poun <br /> Y -Yard <br /> ❑ F10- Othe <br /> � I <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Pali 260 10 or any applicable <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> Generator Authorized Agent Name Siig—natuW 0or Shipment Date <br /> TRANSPORTER <br /> R p510-634-6$50 <br /> Truck No {` Phone No <br /> Dillard Truckins; Inc 2/55 <br /> Transporter Name Driver Name (Print) <br /> P C Box 218 <br /> Address Vehicle License No/State l <br /> Byron California 94514 <br /> Vehicle Certification <br /> I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered wi <br /> at the generator site listed above out incident to the destination listed below <br /> d <br /> i <br /> Driver Signature Shipment Date Dr nate Delivery Date <br /> DESTINATION <br /> Site Name B F I fiasco Road Landfill Phone No 1 0 — 4 4 ; Q t 9 <br /> 4001 Nortll kasro Rd Livermorc Cd 94550 <br /> Address <br /> l hereby certify that the above named material has been accepted and to the bes tl�avl a foregoing is tr a and accurat <br /> of AuthoniedAgent Sr nature scar Date <br /> PASS CODE <br /> 10186 BF12E <br /> S ! f <br />