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x <br /> Waste No <br /> SyStetM <br /> D1 4lNC>rFERR1$INDtJS'!'RlES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> LZIM <br /> • � <br /> Generator Name E=00 Company U.S A Generating Location Faxon Station i7--3330 <br /> P dress ` P 0 Boa. 4415 Address 3128 W Benjamin dolt Dr <br /> HousLun Teas 77310-4415 Stockton California <br /> 5 1 0 _ 6 B T1 _ 1 <br /> Phone No ( -- - Phone No <br /> E I Waste Code L� Containers Type <br /> Desert tion of Waste Quantity Units No Tag D-Drum <br /> 0 0 0 1 8 --j ('� , C-Carton <br /> i NON HAZARDOUS l I I �J B-Bag <br /> T -Truck <br /> SOIL ❑ m ❑ P,Pounds <br /> ' Y -;Yards <br /> El1-1Q-Other <br /> 1 hereby certify that the above named material does not contain free liquid as defined by 40 CFR fart 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 /> if Aattwnzed Agent Name slgriature'e7 Shipment Date <br /> 510-634-6850T _ck No Phone No <br /> Dillard Trucking inc 2 '55 � <br /> T nsporter Name Driver Name(Print) <br /> Address 1' 0 Boy, 2 i 8 `} Vehicle License No/State <br /> ftyron vslifornia 94514 }} <br /> Vehicle Certification ___ n / 1 cis <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 /> ,), w slgsa 11'_ <br /> f S iipment Date Driver Signature Detivery Date <br /> Q F t V1 �r i Roar{ Lindf 111 <br /> �_�__�__ Phone No <br /> S Name <br /> I __ruby certify th,it the above named maten3l has been accepted and to the best o1 my knowledge the foregoing Is true and accurate ] <br /> e or Aulhorq,!O A jNn1 <br /> S(jn al.,n RBce�l Uate — <br />