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UNN RSA'r��ENV.IRONMENTAL V�1No244 <br /> i .,T. <br /> P.O. BOX 996 BENICIA.CA 94510,(707)747-6699 <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name ;R <br /> Generating !:'ovation <br /> Address 900 , Vtoter Rd. <br /> Address <br /> Lodi CA 95240 <br /> Phone No. 16 19— 2 4 - Phone No. $ <br /> Containers Type <br /> Description of Waste i, Quantity Units No. Tpe D-.Drum <br /> Carton <br /> B <br /> a - Bag <br /> t; rtt1ntd soil, 'with & oil �3 T -Truck <br /> mEl <br /> P-Pounds <br /> 3 <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 260A0 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 /> j Generator Authorized Agent Name Signature ` t Shipment Date <br /> ! h <br /> TRANSPORTER <br /> Truck No. —Phone No: 207 747-6699 <br /> . �rau�.z�tstrt . =;, r <br /> Transporter Name. Driver Name;1'(Print); <br /> 1898 Park Road R9d'� � s <br /> Address Vehicle License NoJState •'{ l r` :S r"c o k <br /> Benicia, CA. 9451b Vehicle Certification`, <br /> I hereby certify that the above named material was picked up 1 hereby certify that the above named material was delivered with- <br /> at the generator site listed above. out incident to the destination listed below. <br /> { % <br /> t TM <br /> Driver Signature Shipment Date Driver Signature :r Delivery Date <br /> \ IJi <br /> STINATION <br /> . .��.. . ,`, <br /> Site flame � Phone No. <br /> Address 1145 V. Charter Way, Stoc;kt-61,,s CA .95206 ;k <br /> ►eby certify that the above named material has been`accepted,and to,t s best o my knoyyledge the foregoing is-true-and accurate. <br /> •P''"4 Mp � ,,�� � .w � h 4 ���yam'�h ,/ Wr <br /> ' Name or AUShOriZed Agent ; �—P---�� ✓r'�.•••.,4•`" ` � +••'' ,.w' J1 '�.:+",,.t <br /> ` Signature _ <br /> ' _ � __ Receipt Data <br />