Laserfiche WebLink
,0W <br /> LFMIJN_1VeFtSAL ENVIRONMENTAL sN n <br /> - 2636 <br /> P.O.BOX 996,-BENICIA,CA 94510,(707)747-6699 <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name Tcco l aYt59Yt Ptt �31! Generating location Same <br /> Address 900 i Victor Re., Address <br /> ?,ndi, CA 05240 <br /> 2 — 6 8 2 4 7 2 <br /> Phone Na Phone No. <br /> Containers Type <br /> Description of Waste Quantity Units No. T e D-Drum <br /> C-Carton <br /> w t B- Bag <br /> Contaminated $oil. With Fuel 01 ❑ m ❑ T -Truck <br /> tti <br /> P -Pounds <br /> Y-Yards <br /> Elm ❑ 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 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 Signature. �." Shipment Date <br /> TRANSPORTER <br /> Truck No. — •' ° r... s Phone No. 707-747-6699 <br /> Transporter Name Universal, Env:irotzent al Driver Name (Print)—! ^ <br /> Address 1898 parkRoad Vehicle License No./State° <br /> Benicia+ CA 94'510 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 fisted below. <br /> �`.,y , <br /> .. I r,:..z.sJn. . 3,�' r`j,,.,xrr 5;,��... �,•, ,,� ice= �� <br /> Drtver Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name Fora*tri Landtil l Phone No. � --4 6 4— 8 E <br /> Address 1145 W. Charter "day,, Stockton, CA 95206 <br /> 1by certify that the above named material has been accepted and-6 the best of,my k;'howledge the,,foregoing is true and accurate. <br /> _4 F6777 <br /> -•, w <br /> Name of Authorized ant -• •••-,• _••Si'nature•__- „-• ,',r' J Receipt Date <br />