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A R e <br /> UNIVERSAL ENVIRONMENTAL No <br /> P.O.BOX 996,yBENICIA",CA 94510,(707).747-6699 <br /> E <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> �� II <br /> GENERATOR <br /> Generator Name Ta�osi Transportation Generating Location <br /> Address 9010.-I Victor d. Address ° <br /> 1 i <br /> Lndi, CA 952-40 <br /> t <br /> Phone No. 3 16 18 12 !t 17 12 Phone No. <br /> f <br /> { If Containers Type . <br /> �. )escri tion of Waste it .Quantity. Units No. Tpe 0-Drum ; <br /> C-Carton <br /> tp f <br /> t;rsr?t;anlraat:ed 5oll V.&f~h ftel F, Oil _ EIm ElT -Truck ' <br /> P Pounds <br /> Y-Yards i <br /> O. Other <br /> I hereby certify that the above named material dbes not contain free liquid as�idefined by 40 CFR Part 260.10 or any applicable i <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applical7le state law, has been properly described, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations. kI1F <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. ,I, � /r 074A -6 9R <br /> .,, Phone No. � <br /> ..Trans iter Name :{ tv: l' rtava1. � ' I "" <br /> t Po Driver Name (Print} .- ..- <br /> } r3 �ark, Road - <br /> Address Vehicle Licensi_e No.IState ".,:��_�_ F .w..^ ,s„_•_. ”` <br /> . � ,`Cl% 94,510 <br /> y.. <br /> s <br /> ,Vehicle Certification <br /> ' ( >I M� <br /> 'I hereby certify that the above n med material was picked up x I hereby certify that the above named;6terial was delivered with- i <br /> at the generator site;listed,a,ove. �� out incident to the destinat ndi'dde ,,below., <br /> F- ,} - <br /> Qriver Signature* Shipment Date eDriv�vSi6nature f?. i f \ l <br /> _,pelivery Date <br /> DESTINATION !3 <br /> i <br /> F. Site Name �,r:.�+��Ia, .. r � <br /> I Phone No.:` <br /> 1.14. i4r. Clla te—r �Ayo t�ockt oik A X5206 s <br /> Address . <br /> t 'iby certify that the above named material has been accepted and to the best obiy"knowledge tha�'fofegoing is true and accurate. <br /> � Y,, <br /> h Name of Authorized A ent Signature' _ Receipt Hate <br /> i� <br /> i <br /> J <br />