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33 UNfVERSAL;ENVIRONMENTAL <br /> i — P.O.BOX 996;BENICIA,CA 94510,(707).747-6699 ` <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST 4 <br /> GENERATOR { <br /> Generatdr Name 'eea'fo { Generating Location. 8e <br /> Address 900 -1 Victor, Rd° Address Ali <br /> hod:€., CA 9524077 <br /> Phone Na. I;z67s Phone No , <br /> 14 17 F <br /> Containers Type <br /> Description of Wastek Qtjan'ti Units No T pe D- Drum <br /> C Carton <br /> z N ® <br /> 3 Coat:t€a3nin.nted $oil. Vit h -Fuel. & u ¢ �i T -Truck r <br /> ❑ m} ❑ P Pounds <br /> i Y Yards <br /> ­A. r ; �' f N 0 -'Other <br /> I hereby certify that the above named material does not contain free liquid as'Fdefined 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 property 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 t <br /> l Truck No.. ., >� `f .. ` ° Phone No. <br /> Transporter Name Driver Name (Print)1898 park ROA1111 <br /> Address Vehicle License No./State <br /> Vehicle Certifications 7 <br /> Thereby certify that the above�hamed material was picked up 1 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 Date Driver Signature 3; Delivery Date <br /> DESTINATION <br /> Fr,)7%ard <br /> l Site Name � _ - � Phone Noa & y , Z�� f —a` <br /> i <br /> � Address .,1145 14. Charter ljc-L , Slt'tsrkio A CA 95206 • ,� <br /> 1•,r',)by certity that the above named material has been accepted and to-the best of my,knowledge the foregoing is true and accurate.Vr­ <br /> ; <br /> .' s f .r J r 'iryrJ"! ✓f'`�' - L^- _ 5,. ..s a Q0 <br /> Name of Authorized A eng t Signature T Receipt°Date <br /> — <br />