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X <br /> Waste No 691564 <br /> i <br /> Systems riie NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> RNING4"ERRIS INDUSTRIES } <br /> Exxon Station *7-3330 <br /> C° y D S A Generating Location <br /> CRrugrator Name ------- <br /> Andress <br /> P 0 Box 4415 Address 3128 W Benjamin Holt Dr <br /> Houston Texas 77310-4415 Stockton California <br /> 8 1 0 ^ 2 4 8 8 7 0 0 <br /> Phone No Phone No <br /> Containers Type <br /> E t Waste Code t�--�—i to Drum <br /> Description of Waste QuantiELL= Units Na '� e C-Carton <br /> 0 0 0 1 8 � 8-gag <br /> T Truck <br /> NOWT HAZARDOLS ❑ � ❑ P-Pounds <br /> SOIL <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 26010 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 regulalxonnsAs <br /> Q r� fl !`� Q Z CJ <br /> � 111111 : <br /> 02 T <br /> Aor/wthorizad Agent Name <br /> nature Shipment Date <br /> rv- <br /> r <br /> "` �. 510-634-6880 <br /> Thick No Phone No J <br /> Dillard Trucking Eric 2 55 !tom <br /> T nsporter Name unver!Name(Print) <br /> P 0 Bo♦ 218 Vehicle License No <br /> Address IStata. ff-� �r <br /> Byron California 3151.1 2 Qy 3 _5 <br /> Vehicle Certification �--- <br /> t hereby certify that the above named material was picked up touts out dent to the destination I ed below <br /> nal was delivered wtth- <br /> ai he generat ite fisted above <br /> r <br /> 2 � Delivery DalO <br /> Shipment Date Driver Signature <br /> sr Signature <br /> e r y <br /> j <br /> 1 } l y �i <br /> Phone No <br /> Name J� �3 <br /> Andress <br /> {;r,^hy cert+ty that the above named malerral has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> Roc rpi Daie <br /> 7 al Authorized Agent <br />