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Waste No 854317 <br /> Systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> IVyNIl�lG-FERRIS INDUSTRIES ' `O' `-HA`"� <br /> • <br /> ierator Name etiolt Coinpan\ VS AGenerating Location E\tin ' St ai Lori :7-3330 <br /> Iress P 0 Box 4415 Address 3128 h Benjamin Holt Dr <br /> Houston Teas 77310-4115 Stockton Califoinia <br /> me No a 1 0 2 -} G 8 7 0 0 Phone No <br /> Waste Code 0 6 1 i 9 2 1 9 6 1 7 Containers Type <br /> Description of Waste Quantity Units No Type D- Drum <br /> C - Carton <br /> 0 0 0 1 S E lil B _ Bag <br /> \0N HAZARDOE:S <br /> T -Truck <br /> SOIL ❑ m ❑ P - Pounds <br /> Y - Yards <br /> ❑ l� J F-10 Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable <br /> state law, 1s 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 fMnstion according to applicable regulations <br /> 2-1 <br /> aerator Authorized Agent Nalne Signature Sh,pmeni jDa.te <br /> • <br /> '- 510-634-6850 <br /> ick No (y- Phone No <br /> Dillard Trucking Inc Driver Name (Print) <br /> � �✓ � ' '� �' � <br /> nsporter Name ?� <br /> dress P 0 Boa 218 Vehicle License No /State �� y <br /> Bvron California 94514 r?c J40 /? <br /> Vehicle Certification <br /> ereby certify that the above named material was picked up I hereby certify that the above named material was delivered with <br /> the generator site listed above out Incident to the destination listed below <br />�erSignalur� Shipment pate Drover Signawre Dolrvery pate <br />' � f <br />[e Name B F I Vasco Road Landfill Phone No 0 1 0 r ] <br /> 4001 North Vasco Rd Livermore Ca 94550 <br />]dress /� <br /> iereby certify that the above named material has been accepted and to the best of my-Mi� edge the foregoing is true and accurate <br /> i� <br /> Gazed A ent Si nature Receipt Date <br /> PASS CODE <br /> 186 BF1260 720 <br />