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r Waste No 691554 <br /> Systems iM <br /> 3RD ING-FEIritilSlHAUSMIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> MM • . <br /> Exaoa Company U S A Exxon Station *7-3330 <br /> 3t erator{Varna Generating Location <br /> %ddress P 0 Box 4915 Address-3128 w Beniamin Holt Dr _— <br /> Houston Testas 77310-4415 Stockton California <br /> 'hone No �0 0 Phone No <br /> - <br /> 31 Waste Code m Containers Type <br /> Description of Waste Quantic Units No Te C Drum <br /> 0 f 0 0 1 8 C-Carton <br /> B Sag <br /> NON 1iAZARDOLS T Truck <br /> SOIL ❑ m F, P-Pounds <br /> YYards <br /> F-1❑ m 0 Other <br /> 1 hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 100 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 property described <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> 'CG b F M o4RzU E�-¢ <br /> Ge..rator Authorized Agent Name Signatur Shipment Dato <br /> i <br /> am • <br /> 310-634-6850 <br /> Truck No �j Phoria No — <br /> Dillard Trucking Int, 2 53 <br /> Ti isporter Name Driver Name(Print) <br /> Address P 0 Boa 218 Vehicle License No/State x <br /> Byron California 94514 ^ (, <br /> Vehicle Certification <br /> I hereby certify that the above name' material was picked up I hereby certify that the above named materiel was delivered with <br /> at ie generator site listed above out incident to the destination listed below <br /> )l <br /> �r r rgnalure {� Stir ant Date om Signawre D Ilrery Data <br /> r <br /> (t • <br /> i=4.1 t ? t l <br /> _�i Name ---- ----- <br /> Phone No <br /> 5 <br /> At rens — — -- 4 <br /> i he v certify that the above named material has been accepted and to the best of my knowledge the foregoing <br /> is true and accurate <br /> S. raturp _ <br />