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a <br /> 'UNIVERSAL� ENVIRONMENTAL <br /> P.O:80X-996,BENICIA,CA 94510,(707)747-6699 <br /> ii <br /> `t NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR jt <br /> �r I <br /> Generator Namee gMe�a�f 't' tscaatt Generating Location Same <br /> Address 900 1 y c'tar W1. Address <br /> T,odi, CA 95240 <br /> Phone No. 0 9 3 1 6.18 1 2. 1Phone No. <br /> P Containers Type <br /> Description of Waste td Quantl Units No. T e <br /> O Drum; <br /> C Carton: <br /> `rWTI <br /> T B - Bag <br /> T -Truck <br /> d;, . r inttt $ail D r ❑ m ❑ P - Pounds.. <br /> i <br /> Y-Yards <br /> P m 7 O Other <br /> t hereby certify that the above named material does not contain free liquid as'idefined.',by 40 CFR Part 260.10 or,any applicable , <br /> 1 state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> yl 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. r't r� '; Phone No. il7707-147w 699 <br /> i€ <br /> Transporter Name i7 s `' d t tit a Driver Name (Print)1,898 <br /> AddressVehicle License Nod tate <br /> 4. &teiiici;5'n CA 94510 Vehicle Certification <br /> i3 <br /> I hereby certify that the above named material was picked up l 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 /> u f•? " <br /> i. . .1..ser r.. .�!{.:.��..��. .✓^f.`.°!:..'",. � �f a �� �'" -!..,-F, k ^""«,° y,. �" 1 <br /> Driver Signature Shipment Dale Driver Signature ��j Delivery Date <br /> DESTINATION <br /> Site Name i��:p-WL,rd �,,ol�r����� Phone No: <br /> �" � �' — 4 6 6 4 A <br /> Address 1145 W. Mo,yi r Wnyb Stockton' CA 957t..M <br /> !, �,.ted"`" - ,' ,. '��,- -ik �,,.y' -- � ..,4..�• <br /> i iby certify that the above named material has been accepted'and tgfihe bJe��st,of my�6owledge thy-foregoing is true and accurate. <br /> Name of Authorized Agent �- "^ Signaturer�, .. Receipt Date° <br /> - - t, <br />