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UE <br /> UNIVERSALsENVtQNMENTAL a <br /> P.O.BOX 996,BENICIA,CA iS4510,(io7)747-6699 <br /> 5' <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> ST <br /> { GENERATOR <br /> Tereei Transportsaticra Same <br /> Generator Name Generating Location <br /> Address 900 1 Victor Rd. <br /> Address <br /> Lalli, CA 93240 <br /> Phone No 2 0 9 T13 6 8 2 4 _17TY] <br /> Phone No. T <br /> Type <br /> Containers <br /> R D-Drum <br /> Description of Waste i puantit Units No. T e <br /> C-Carton':. <br /> P' B-Bag <br /> Contaminated Soil With Fuel bi Oil ! T -Truck <br /> l / m 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 �O 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 transportation according to applicable regulafions. <br /> ] Generator Authorized Agent Name Signature L Shipment Date <br /> TRANSPORTER <br /> Truck No. � a •' Phone No. 707-77-5699 <br /> Udiversal Environmental 1 <br /> Transporter Name Driver Name (Print) � , r) � �=�`��.'-� 4'` �` ,'�..• <br /> 1898 Park Road j is �; <br /> I Address Vehicle License No.IState r� ✓ __ l `� <br /> Y;. <br /> Benicia, CA 94510 i <br /> i <br /> Vehicle Certification <br /> I 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 List above, out incident to the destination listed below, <br /> Driver SrpnalunShipment Date DrivirZignatura ;y Delivery Date <br /> �. <br /> DESTINATION <br /> Forward Landfill i <br /> Site Nameii <br /> Phane No. <br /> Address 1145 W. Charter Way, Stockton, CA 95206 <br /> 1 �ie)iy certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> ! Name of Authorized si ure :+ Aacei t Dnle <br />