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UNIVER UL ENVIRONMENTAL ;, a <br /> Y kSVI <br /> § P.O.BOX-996.�BENICIA,CA 94510,(707)747-6699 x <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST ' <br /> t <br /> GENERATOR 4 i <br /> Generator Name `dei ' st� to 1 <br /> Generating Location t <br /> Address 00 Victor Rd,, Address ' <br /> ' <br /> Loidlo' CA 95240 <br /> 2 --:t ti S 2 1 -- <br /> Phone No.� 2 Phone No.. <br /> f Containers Type <br /> Description of Wasteib Quanfi Units No. T Pe D- Drum <br /> C-Carton <br /> $ag. <br /> CO"tamillated 5011 €it h T't.A61 & oil T -Truck <br /> ❑. m ElP Pounds <br /> Ar. Y-Yards <br /> /7 761 <br /> t ❑ m F] O Other <br /> t <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 /> C 'state law,.isnot 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 /> CQ <br /> GeneratorAuthorized Agent Name Signature. Shipment Date <br /> TRANSPORTER <br /> Truck No. Phone No. 707-747-6659 <br /> Transporter Name UritLt x3:t .sac. Driver Name (Print) <br /> li 1898 T?arl-W Thad. i, v ; <br /> Vehicle License No./ tate. ' <br /> Address <br /> 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 /> "�� �r 1 <br /> „.y..u• aj t a -,., #- f � <br /> (;.f, 1.ad't;' u! ..,d:. •io +,'r d'14....._ L .. <br /> S <br /> Driver Signature Shipment Date Wives Signature j= Detivery Date <br /> DESTINATION l <br /> Site Name Phone No.11-45 W. Char6tr Way, stocktor, <br /> i <br /> Address <br /> +eby certify that the above named material has been accepted and to,the best,of my knowledge the foregoing is true and accurate.5 <br /> r• ! �'!" F ', '+°-F ' r ,H •'t :. f, y � _ k - - �� a .r, '�y <br /> ?.. -__ �'*'_ . 'r .-'r i ,,,' � .� k,ti` w '�� r ."wri,{xs.... '�i,... a ;' £,°t..+.'A ',l .•�,:a:';�t <br /> ` Name of Authorized Agent 71­.,,-:Signature :yx j r` Receipt Date <br />