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a Waste Na 691553 <br /> �,� Systems � NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> '-RneratorrName' 1 lrxXoa COMPany U S A <br /> Generating Location Exxon Station tl7-33$0 <br /> dress _ P 0 Box 4415 Address 3128 h Bert jnlein Holt Dr <br /> Houston Texas 77310-4.315 Stockton California <br /> 'hone No � Y 0 — 2 4 6 8 7 0 0 <br /> Phone No <br /> I Wasje Code l= J ContainersFD <br /> fjescn tion of Waste Quante Units Na T g <br /> 0 0 0 I g NOh HAZARDOUS <br /> SOIL T -Truck <br /> F-1 l P-Pounds <br /> LLLL������� Y-Yards <br /> JEE= El ❑ O Other <br /> I hereby certify that the above named material does not cortam free liquid as defined by 40 CFR Part 260 10 or any applicable <br /> stale lawn is not a hazardous waste as defined by 40 CFR Part X61 or any applicable state law has been property described, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> Ci�3 Y -OrEAgent gent ��Z a <br /> Authorized <br /> Name Srgrratur <br /> Shipment pate <br /> • s <br /> Titbck No 510-634-6850 <br /> Phone No _ <br /> T nsportear Name Dillard Trucking Inc 2, 55 <br /> Driver Name <br /> Address P 0 Box 218 <br /> Vehicle License No/State <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 with <br /> - <br /> a he rator site listed above out incident to the destination listed below <br /> Dh rrSignalure — PW <br /> Shipment Data p of sign to / <br /> ' Delivery Data <br /> � 0 <br /> S Name <br /> i <br /> - — -- Phone No <br /> Address <br /> I ^hy certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> - ori au h,n,,zed 4geni _- — - --- — — i <br />