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r <br /> ' Waste No 691557 <br /> ems <br /> 3t; ttN ,' � ES - NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Exxon Company U S A Exxon Station 57--3330 <br /> anerator Name Generating Location-- -- — <br /> 4udress A 0 Box 4415 Address 3128 W Benjamin Holt Dr <br /> Huust:on Teets T7310-4413 Stockton California <br /> phone No 5 1 0 2 4 ti 8 7 0 0 1 <br /> one �� <br /> Phone <br /> No <br /> I Waste Cade m F ILJ <br /> Containers Type <br /> Description of Waste Quantity Units No Type D-Drum <br /> o o a l a a <br /> IC-Carton <br /> LJ B-Bag <br /> NON HAZARDOL S T-Truck <br /> SOIL <br /> P-Ptwnds <br /> Y-Yards <br /> ❑ F] O-!her <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, 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 /> I <br /> Lr Authomed Agent Name Signature Shipment Dat@ <br /> 0 <br /> sla-639-naso r <br /> Truck No .�L�..-..-_._.___,_ Phone No <br /> Dillard Trucking Inc 2 55 <br /> T tnsporter Name Driver Name(Print)�lJlf <br /> Address _ P -0_ got 218 Vehicle License No/State 4-7,-" <br /> Bron C, !,'c iiia 91�111 <br /> Vehicle Certification A- <br /> I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with <br /> a he generator site listed above out incident to the destination listed below <br /> TFe -I <br /> eYSgn� ,. Shipment Date Driver San's a Deirvery Date <br /> o • <br /> 3 r f lb „ puad LandCt ' i 5 1 f a 7 0 5 0 <br /> a 1 ame -- --- - ------- -- --- - - ----- Phone No F <br /> Iddress <br /> shy certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> Receiiil Dairy — <br /> t <br />