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LE <br /> UNiUElSAL;ENVIRONMENTAL <br /> li P.O:BOX 996 BENICfA,CA 94514,(707)747-6699 <br /> NON-HAZARDOUS SPECfAL WASTE MANIFEST <br /> GENERATOR <br /> i <br /> Generator Name ot^ t; �ta , re <br /> Generating Location <br /> Address 900 victt of k34. <br /> Address <br /> t 85240 <br /> Lodi. t;x� <br /> Phone No. x f — ?, iB . <br /> . Phone No. „�� <br /> p Containers Type <br /> Description of Waste ®uaintit Units No. T pe D-Drum' <br /> 6 x� ; ' C Carton <br /> B Bag <br /> opt :�a avod S���i.�. with Fall & Oil r T -T", <br /> t <br /> P _ Pounds <br /> t Y-Yards <br /> O. Other:�:" . <br /> I hereby certify that the above named material does not contain free liquid as deftne&dby,40 CFR Part 260.10. or any'appiicable <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'lo applicable regulations. <br /> Generator Authorized Agent Name Signature; Shipment Data <br /> i{ I <br /> 1. <br /> TRANSPORTER <br /> Truck No. ' w. - Phone No. ] 7t7t ^ t9 <br /> Universal Ea i rottme�tk � <br /> Transporter Name Driver fume (Print) <br /> los <br /> Address Vehicle License No./State _ <br /> ori o18 ' 94510. <br /> Vehicle Certification <br /> ,l <br /> I hereby certify that the above named material was picked up I hereby certifyithat the above named material was delivered with <br /> at theeneraior site to listed above. out incident to the destination listed below. M <br /> unver s+gnature Shipment Date Driver Signature e 9 Delivery pate <br /> I <br /> DESTINATION <br /> ,i <br /> i <br /> Site Name j 61 ,�S 4 �a t <br /> Phone No. <br /> Address 1:145 Wo Chn t:er Way, 5t otkt on, .t'& 9$206 � , <br /> eby certify that the above'named material has been accepted and to tht# bestof my knowledge the'fbregoing is true and accurate. <br /> i r I �'• � � <br /> � - ] F �•s 1`� ...fi � �" � � 4 <�;" � �,d .F. b.. �Al, �I„q'` Wn':.'.� �if�•o� <br /> Name of Authorized Agent Receipt Date <br /> Sj nature' <br />