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jt h l Q � <br /> k U IVERSi1L ENVIRONMENTAL . <br /> P.O.'60X 996 BEN ICIA,CA 94510,(707)747-6899. <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name Te Desi. Tranaportat4j,01 Generating Location Sarno- <br /> Address 900 Victor Rd. Address <br /> 5240 <br /> Phone No. —3 6 4 7 F2 Phone No. <br /> Containers Typei <br /> Description of Waste l Quariti Units 'No. Type C- Drum M <br /> � C-Carton <br /> w 1< B -Bag <br /> l o'ai a <br /> .50U. Wab Fuel 011. T,-Truck <br /> �. m ❑ P -Pounds <br /> ii Y-Yards. <br /> /,7 Lz�l � m � Q- Other <br /> i <br /> I hereby certify that the above named material does not contain free liquid asdefined 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, 1 <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations. I <br /> 'r <br /> ell, <br /> ,r ., ✓'�✓.e?.`".- -.: ,� ��A'', ' W"rL`.r,�,tlR I t - •1' 3 f G.- .. <br /> > <br /> Generatar Authorized Agent Name ignalltro,, Shipment Date <br /> TRANSPORTER <br /> I Truck No. ✓ ! r ° Phone No. <br /> : .�� �; &�.E <br /> } Transporter Name Driver Name (Print) .� Iy'K s r:#J <br /> 1898 park Road <br /> t Address Vehicle License No.IState �' ' ✓ „ ' <br /> CA 94510 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 /> ortGer Signature Shipment mate •Driver Signature i� Delivery Date <br /> i ... <br /> DESTINATION <br /> Fotvar4 Landfill 14 <br /> Site Name Ph{one No” ; <br /> Address 1145 e 1u�.wrtoer �� y. 'Stoc E�.t ex a.., CA 9. ,2.06 , <br /> by certify that the above named material has been a <br /> ccepted andto the,best l}of my,k�owledge,th'af foregoing is true and accurate <br /> �� <br /> ?, �Ok..r�-•,.v;, S `"�,,.adn -L.`�,•..,, _ Ks _ ... I[' _..,, -`i ... f Y W f:✓'. - d '` <br /> Name of Authorized Agent signatureFiecaipt Hale <br /> -- _ <br />