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x <br /> OaWaste No 6 91 S F 1 <br /> Systems <br /> R PING-F@iiRlS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> 0 <br /> Exxon Company U S A. Exxon Station *7-3330 <br /> ierator Name _ - Generating Location <br /> ddress __ P n Box 4413 __ __ Address 3128 W Benjamin Holt Dr <br /> Houston Teras 77310--4415 Stockton California <br /> hone Nos 1 i—I2 4 6 8 7 0 Phone No <br /> IJ <br /> t Waste Code Containers Type� <br /> Desch tion of Waste QuantityUnits No Tie D Drum <br /> 0 0 0 1 8F l__! �3 I= i C-Carlon <br /> f—! L tLL_____7]] B-sag <br /> \0N H4ZARDOLS T-Truck <br /> SOLI. ❑ m <br /> P-Pounds <br /> Y-Yard!: <br /> ❑ m ❑ 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 pa/c1.ka�g5ed], and is in proper condition for transportation according to applicable regulations <br /> r- /y <br /> ator Authorized Agent Name signature ship[rent Data <br /> • 0 <br /> 510-634-6850 <br /> ruck No -_- Phone No <br /> Dillard Trucking Inc 2/55 <br /> r tsporter Name Driver Name (Printr „ <br /> c �i9 s — <br /> ><ddress P 0 Bas 218 Vehicle License No!State - <br /> Bvron California 94314 <br /> Vehicle Certification <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> ,t ie generator site listed above out incident to the destination listed below <br /> !i <br /> n Signature shipment Date u D rvery ate <br /> 1 • <br /> A <br /> %-­1 °uad Landf i l l9 <br /> Phone Na <br /> Name — <br /> +el ess <br /> t, v certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> A_Ih 11, e�J Awe nl Y ---�— _ Sgna[ura Rrce,pt Oai< <br /> ra",GOU - <br />