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r <br /> .` a via - N0 691559 <br /> Systems <br /> I Inc-MKS INOus=wEs NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Fxx6n Company U S A Exxon Statlon *7-3330 <br /> -nerator Name Generating Location <br /> sjress P 0 Box 441 ' Address 3128 N Sen)amin Holt Dr <br /> Houston Texas 77310-4115 Stockton California <br /> hone No Phone No <br /> Waste Code <br /> Containers Type <br /> � � <br /> Description of Waste_ QuantityUnits 0� Type p_prom <br /> - - --- � C-Carton <br /> 8-Sag <br /> NON Ii.�ZAR>3DGS ❑ m ❑ T -Truck <br /> SOIL P-Pounds <br /> Y-Yards <br /> T-771 ❑ ❑ O Other <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 /> ,,r Auttwnzw Agent Name signature, Shipment Date <br /> i <br /> 7� 51(3-634-6850 <br /> ruck No Phone No <br /> Dillard Trucking Inc 2/55 � <br /> - LIZ- <br /> P <br /> r isporter Name Driver Name(Print)address 0 Bo,, 218 Vehicle License NolState <br /> Bron California 94514 <br /> Vehicle Certification c — <br /> hereby certify thpt the above named material was picked up 1 hereby certify that the above named material was delivered with <br /> A to gen�tof si�iisled above out incident to the-rlestination listed below <br /> F <br /> +1 signature T Shipment oat9 Driver Signature Delivery data <br /> a r T 1 Si o Road andf i i j F=_=4 , Q 4 11 <br /> Name Phone filo <br /> kdr+ress -- <br /> htq^^v certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> r <br /> ,,` of Auihonzetl AQert�-- — ----- —Sign�iwe__ -- I --�— _�-- Receipt Date---�— <br />