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-U-1 <br /> 'UNIVERSAL ENVIRONMENTAE. o SO <br /> P.O.bOX 996;BENICIA,CA 94510,(707)747-6699 <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR , . <br /> Tereai Transportation 3 Same <br /> Generator Name Generating Location <br /> Address 900 } Victor Rd. Address E <br /> Lodi CA 95240 ¢ # <br /> 3 6 8 2 4 7 2 <br /> Phone No. Phone No. ;k <br /> i� Containers Type <br /> .a D=17rum :- <br /> Descri tion of Waste, I <br /> Ca <br /> Quantity Units No. T e <br /> { t� 1 1 `_ ' C- rton <br /> Ed Id B-Bag <br /> Coptaminatad Soil With Fuel & ,,,Oil ;I T ..Truck <br /> m ❑ P-Pounds <br /> J _ Y-Yards ., <br /> I s ❑ 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 CPR Part 261 or any applicable state law, has been properly described,. <br /> classified arid.packaged, and is In proper condition for transportation according to applicable regulations. <br /> 41 <br /> Generator Authorized Agent Name Signature ;; Shipment pate <br /> .L 3 <br /> TRANSPORTER <br /> Truck No. i L` 1 3 3 6 '� Phone No. 1,107-747-4699 <br /> Transporter Name Univ®real Environmental } <br /> t: Po Driver Name Print 9 '�► <br /> Address 1898 Park Road li 7 <br /> Vehicle License No./State yu <br /> Benicia, CA ..94510 ; <br /> Vehicle Certification <br /> it <br /> hereby certify that the above named material was picked up I 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 /> Ij <br /> Driver Signature Shipment Bate <br /> Driver Signature - Delivery pate r <br /> t <br /> DESTINATION <br /> Site Name Forward Landfill — A 6 >S +� 4 8 z <br /> Phone No. <br /> �. 1145 W. Charter Way. Stockton, CA 95206 <br /> . Address . <br /> i ' <br /> I l" )y certify that the above named material has been accepted and to the best of my knowledge the foregoing Is true and accurate. <br /> � i <br /> Name of Authorized 69sm rsionature <br /> a. <br /> Receipt pate <br /> !rI ,: <br />