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4MWaste No 691556 <br /> systems TM <br /> RO tAGrF9ftSIND STMES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> i <br /> +t arator Name , xxan CaM�Y D S A Generating Location Exxon Station 97-3330 <br /> Address ress <br /> P 0 Sox 4415 3128 W Beniamin Holt D. <br /> - <br /> Rouston Texas 77310-4415 Stockton California <br /> hone No Phone No �� I <br /> F Waste Code Containers Type <br /> Description of Waste Quantity NOType D-DrumC-Carton <br /> B-Bag <br /> NON HAZARDOUS T -Tit,^k <br /> SOIL ❑ ❑ P-Pounds <br /> I� Y -Yards <br /> ❑ m ❑ o-Other <br /> 1 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, 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 /> razor Authorized Agent Name Signature iV Shipment Date <br /> gpig <br /> 510-634-6850 <br /> 'ruck No Phone No <br /> Dillard Trucking Inc 2 55 <br /> Fr r isporler Name Driver Name(Print) 4D <br /> kddress P 0 Box 218 Vehicle License No/State <br /> Bvron California 94514 <br /> Vehicle Certification _ D t >? <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> it io generator site listed above out incident to the destination listed below <br /> 3r w Sgnaiure Sh,pmant Date Drnor Signature DettveryDate <br /> e e <br /> 3 Name F i t as r ri R -1 [ l i sl f S Phone-No- = 1 <br /> 4 cress <br /> he v certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> — <br /> » S, nature _se n1 Authon7ed Agent � ._ Receipt Date <br /> ._ f,NSI;CODE <br /> i <br />