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LIEUN WEA1 'tAL"ENVIRONMENTAL No <br /> 1. P.O.-BOX 996,BENICIA,CA 94510,(707)747-6699 <br /> V <br /> t <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR $ <br /> Generator NameT 'w n rrzrt i t Generating Location. <br /> Address Address- <br /> Lodi, <br /> ddressLodi, CA 95240 <br /> Ili w — w' S8 12 14 7 <br /> Phone No. 10 19 Phone No. <br /> Containers Type } <br /> Description of Waste 1. Oua'ti Units No. T e D-Drum <br /> C-Carton <br /> Z 8 Bag <br /> Contalu na ted sol it hUP-1 oil T -Truck <br /> ❑ m ❑ P -Pounds <br /> f yw <br /> �! Y-Yards <br /> LL <br /> 1:1m 11O. Other <br /> I hereby certify that the above named material does not contain free liquid ass,,ldefinetf 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 a'pplicatle state law, has been properly:described, <br /> classified and packaged, and is in proper condition For transportation according to applicable regulations. <br /> + generator Authorized Agent Name Signature} Shipment pate <br /> TRANSPORTER1707-747-66139 <br /> .i s <br /> Truck No. _.\ 4 3-' Phone No. <br /> pa �'nive:oat 'a;nvironwz r.taI Driver Name 11Print) <br /> Trans iter Name F <br /> Address IM Park ;oa i 3 <br /> Vehicle License No./State <br /> Vehicie Certification <br /> 'p <br /> w 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--generdtor site listed above. out incident to the destination listed below. <br /> L-0 d •... P.*.�A t: '.ti�"i � �35✓r P:. k�l' Y.'f r, - <br /> Driver Signature Shipment Date Drivmr Signature '+ <br /> - g ie Delivery Data i <br /> OESTINATION <br /> Forward Landfill <br /> Site Name 7 <br /> Phone No.'[ — <br /> 1145 W. Charter V ` � <br /> Address 19 St;ot t;on, Gni. 5206 I <br /> 1'�9by certify that the above named material has been accepted'and,to the best of my"knowledge thfoiggoing.is true and accurate. <br /> 1 vI A ...� F r�4.�'S ri>': d •tom.,/i • R: .l ,-� �A„'Wr'1'a� �{ k'w+.^u ,'5 �.1 i �J�r +' _� ,F"`t� �K+,ci•w <br /> -- .- 1. y :." ,p-•, �YY -.eta' � .en ✓' dew, <br /> Name of Authorized A ent —'signature. Aecei t'Date <br /> r ; <br /> Cdr <br />