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ENVIRONMENTAL <br /> P.O.BOX 996, BENICIA,CA 94510,(707)747-6699 <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> S <br /> Generator Name Generating Location <br /> t <br /> Address 1 ' is C_ ii'* <br /> Address <br /> Phone No. Phone No. <br /> Containers Type <br /> Description of Waste Quant ty Units No. T pe D-Drum <br /> C-" Ca <br /> 0( L!_j <br /> B - Bartong <br /> 0 14. <br /> T ,Truck <br /> (7 G I P - Pounds <br /> Y -Yards <br /> 0-Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40.CFR,Part',260.1 0 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 /> Generator Authorized Agent Name Signalur6 Shipment Date <br /> TRANSPORTER <br /> Truck No. Phone No. <br /> Transporter Name Driver Name (Print) <br /> Address Vehicle License No./State <br /> 'a as 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 listed above. out incident to the destination listed below. <br /> Driver Signature Shipment Date Driver Signature Delivery Dale <br /> DESTINATION <br /> Site Name Phone No. -14/ 16 16 ��v) <br /> Address '�K.4. <br /> 'eby certify that the above named material has been accepted an'd.to/the best of my knowledge the foregoing is true and accurate. <br /> Name of Authorized Agent Signature <br /> Receipt Date <br />