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"UNIVERSAL ENVIRONMENTAL kL <br /> P.O. 8OX996, BENICIA. CA 94510, (707)747-6699 <br /> NON-HAZARDOUS SPECIALWASTE MANIFEST <br /> -:V" <br /> GENERATOR <br /> Generator Name-Tc 4.� <br /> Generating Location <br /> Address "d Address <br /> Phone No. Phone No. <br /> Containers Type <br /> Description of Waste Quanti!y UnitsJ No. T,p,e D-Drum EJ2 i_ C-Carton <br /> B- Bag <br /> T -Truck <br /> El m 11 P - Pounds <br /> Y-Yards <br /> Elm 1-1 0-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 � hazardous waste as defined by 40 CFR Part 261 or any applicable I state I Ia' ,k'' has been properly desbribed, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations. <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. 'af, Phone No. IG"i <br /> Transporter Name K%i JJ is <br /> Driver Name (Print) f <br /> Address _C041 <br /> Vehicle License No./State <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 listed above. out incident to the destination listed below. <br /> Driver Signature Shipment Date Driver Signature J Delivery Date <br /> DESTINATION <br /> Site Name <br /> Phone No. ZEM E I I <br /> Address <br /> reby certify that the above named material has beena' c:epte,d and to the b,est<imy-06wledge the fore'goin'g is true and accurate. <br /> Name of Authorized Nent ti,, Si naturei Receipt Date <br />