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x <br /> Wash —Rt--AC - r. -- o <br /> �079 �3--- 1 <br /> Systems TM <br /> PROWNING-'IFERRIS <br /> iNDUSTRiES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> - <br /> • <br /> Mid Cal Leas7nq 1649 E . Chani-lel St <br /> generator Name Generating Location � <br /> ddress — <br /> P p - Box 55103 Address Stockton . Ca <br /> 5t-rocktr n , Ca - 95205 <br /> hone No [IfIfl—I 4 t3 3 S 1 <br /> 0 19 Phone No <br /> 3FI Waste Code C A 4 0 5 _ T9 , <br /> 8 g FT <br /> 7? Containers Type <br />' Description of Waste Quantity Units No Type D - Drum <br /> 8 El [A C- Carton <br /> L�iese'3 Contaminated Soil B - Bag <br /> T -Truck <br />' ❑ � ❑ p - Pounds <br /> Y -Yards <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 packaged, and Is in proper condition for�transportati n accoKding to applicable regulations <br /> I \ is <br /> Ronald K . Rinehart <br /> � � - <br /> enerator Authorized Agent Name Signature Shipment Date <br /> IRAa ,fink <br /> 9 t 5 668-9316 <br /> uck No Phone No <br /> ransporter Name M P Environmental Services Driver Name (Print) �/l G� <br /> tdress 34003 Manor Strcat Vehicle License No /State <br /> tereby <br /> Vehicle Certification <br /> certify that thnabove named material was picked up I hereby certify that the above named material was delivered with- <br /> �t the generator s t 1 ed above out rtc nt to the d t'�iation listed below <br /> )fiver Signature ' Shipment Date Driver Signature Delivery Date <br /> DESTINATI <br /> • <br /> Vasco load Sar - ra,,y L.andf7 l c ,It — - <br /> o Name Phone No <br /> dress 4001 Vasco nc�- Livermore Ca 9,1 n <br /> ereby certify that the above nameri material has been accepted and to the best of my knowledge the foregoing 1s true and accurate <br /> it-f Authorized A e it Signature Receipt Date <br /> PASS CODE <br />'86 - BF1260 720 <br /> GENERATOR RETAIN <br />