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LE <br /> UNIVERSAL ENVIRONMENTAL <br /> f P.O.BOX 998 BENICIA,CA 94516,(707)747-6699 <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Teresi Transportation' i� ; Same <br /> Generator Name Generating Location <br /> l <br /> At#dress 900 Victor Rd. Address <br /> Lodi, CA 95240 i <br /> 2 0 9 4 7 2 F <br /> Phone No. —13 b 8 2 Phone No. <br /> Containers Type <br /> } <br /> Description of Waste 0 a a ity Units No. Type C-Carton <br /> a " 0'�I ;Z 10 1 © 7l B- gag <br /> Contaminated Soil With Fuel 6 0 i i� T -ruck <br /> . �7 �� � m ❑ P -Pounds <br /> +} ;� Y-Yards <br /> f E m D O 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 /> CL_ 214Z, <br /> !} f• // / r� !i <br /> Generator Authorizedant Name ams 5ignaturs ;� Shipment Date , <br /> TRANSPORTER �� 4 <br /> .�/ . ' �f 707-747-0699 <br /> Truck No. Phone No. <br /> Universal Environmental " <br /> Transporter Name Driver Name(Print) <br /> 1898 Park Road � <br /> Address Vehicle License No./State L.�-- jy_/z /1/V4,� <br /> if <br /> 'Benicia, CA 94510 Vehicle Certification <br /> { I hereby certify that•th$ 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 Qats Driver Signature ;-� Delivery Date i <br /> 1 I 1 <br /> DESTINATION y <br /> Forward Landfilld; 2 0 9 4 6 6 4 4 8 2 <br /> } Site Name Phone No. �— { <br /> Address 1145 W. Charter way, Stockton. CA 95206 ;} <br /> I I )y certify that the above named,materfal has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> Nene of Authorized fteirit S nature Receipt Date <br /> " 3 <br />