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LIE <br /> UNIVERSAL ENVIRONMENTAL <br /> 4 P.O. BOX 916, BENICIA,CA 94510,(707)747-6699 <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> v� <br /> Generator Name_ i ":` ,1 1 €t. A_ �, ; r'arw <br /> Generating Location <br /> AddressAddress <br /> Phone No — . <br /> Phone NoF-71— <br /> Containers Type <br /> Description of Waste ;.Quantity Units �No. T+�p»e p-Drum <br /> �.��'��i ' F•'a `s$.: �'�•;'� �:� .r�i ;« ��;•'�` •� �i���k� r � �, T -Truck <br /> P C I ❑ m ❑ P - Pounds <br /> Y -Yards <br /> FTT ❑ L❑ F] 4-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 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 /> � 8f •' rx' ,a ' <br /> Generator Authorized AgenE Name Signature` Shipment Date <br /> TRANSPORTER <br /> Truck No. s ',L i .wa r�..,... Phone No. 1'V -7 4-1 '7- lv':6, T" <br /> Transporter Name 1, 1 0.. '. a�.��c... f'M.1' z, r,.,l e� LLA Driver Name (Print) 2 <br /> Address ` t~ _. ;-t . Vehicle License No.IStatei�C�,'x'440 1"Al Va `"-7?;F <br /> ' w Vehicle Certification '` <br /> I hereby certify that the above named material was picked up 1 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 /> f`j6`.+ `F'`.L'Y-'E....s L� K••..• rr¢ �:..•" f:;• � '� .�.,3..!'•n.,^`i- ,�,r f rw.F'L,+j <br /> Loll e <br /> Driver Signature "' Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name _; ,r .. ,. _.•_.. _..._.. Phone No. t<f ° e <br /> Address <br /> �reby certify that the above named material has been"accepted"and to the best of my••knowledge the foregoing is true and accurate, <br /> -� �-. - .r'� � !'f� ..,,.1'p�r,� ,r"�;�dx� ;/"`T-r•t� <br /> Name of Authorized Agent -5i�nature Receipt Date <br />