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p. <br /> Waste No <br /> 691562 <br /> ystem rM <br /> NdtPICa--FERkIS IND4J5'SRtfS NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> i <br /> ' a I <br /> ,pnerator Name Exxon Company U S A Generating Location Exxon Station #7-3330 <br /> -dress P 0 BON 441-0 Address_ 3128 % Benjamin float Dr — <br /> HCUSton Texas 77310--4415 Stocktoons (California <br /> hone No & 8 7 0 - Phone No �J—L <br /> Waste Code m L I Containers Type <br /> D05cn tion of Waste Quantity Units No Type D-Drum <br /> C-Carton <br /> 0 0 0 2 8 � 0 ! T 8 Bag <br /> NON RAZARDOL5 T-Truck <br /> SOIL ❑ m ❑ P-Pounds <br /> Y Yards <br /> ❑ E] 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 property described, <br /> classified and packaged, and is to proper condition for transportation according to applicable regulations <br /> — F­(' brl'ifV2 11 A' �i <br /> n Authorized Agent Name Signature J;" Shipment fate <br /> 0 <br /> ruck No Phone No 510-634-6850 <br /> r isporter Name_ Ds l lard eructing ,pc 2/55 Driver Name(Print) ) (, ,,)At <br /> ,ddress _ P 0 Box 218 Vehicle License No/State / 2� �- <br /> B}ron Caiifoi iia 94514 ,) D / G _`1 C7 <br /> Vehicle Certification y/ V - ---- ------- <br /> hereby certify that the above named matertal was picked up I hereby certify that the above named material was delivered with- <br /> t ie generator site list above out incident to the destination Its'ed below <br /> TTF,F-r Signature Shipment pate �jr f Signaiura !+ Delivery Date <br /> tt t <br /> Name -- - l� Phone No �—I s r 1 <br /> ddress <br /> ",-hv certify that the above named material has been accepted and to the best of my knowlerige the foregoing is true and accu,ale <br /> pl Au ho�slCd AgCnl_— S�ignalure --_ __.. __-.r _ ._.�i AecE�>�_'�-- <br />