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UNIVERSAL"E"'V ONMENTAL � <br /> N P.4:BOX 996,^BENICIA,CA 94510,(707)747-6699 <br /> r <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> i GENERATOR <br /> Toree erating LocationGenerator Name <br /> Address ` frt.o Tr1v Address. ; <br /> ;F <br /> 'Ludi, CA 95240 <br /> i. <br /> Phone No. EEE_F0_1_8 Phone No. <br /> Containers Type <br /> Description of Waste I .auantit Units No. Type D Drum <br /> C-Carton <br /> B -Sag . <br /> soil. witl1 me]. ul i4 T -Truck <br /> F m El. P -Pounds # <br /> Y-Yards l <br /> Ll I <br /> El <br /> m El O Other <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 /> x <br /> state taw, is not a hazardous waste as defined by 40 CFR Part 261i',or any applicable state law, has been properly described, ° <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations. = i <br /> yt!,, w.«�:'""i•!.,i.yyf� �., �_��.0� .r? :rt' SIF � �� { t„� ,� M <br /> r Generator Authorized Agent Name e Signature: Shipment Date <br /> TRANSPORTER <br /> Truck No. Phone No. <br /> Transporter Name I Print) <br /> s, .•, a • r i <br /> t , <br /> 1850 Park t nAd r? r <br /> { <br /> Address Vehicle License No.IState._ 4 A-) <br /> Benicia, CA 4194510 <br /> Vehicle Certification <br /> i 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.inctdefnjt to the destinattion listed below. <br /> r Jx f t' �•f b'' � 5, .p "r. J .}�.' Yi � '"7 �1'�f,,.. 1 <br /> i <br /> DrNer Signature Shipment Date Driver,Signature ';$ Delivery Date <br /> i <br /> I� <br /> DESTINATION <br /> Site Name orr and 1.and1"il Phone IVo:' � � �,, —4 6i 6 14. 4 <br /> ' Address 1145 TJX Charter Vay, gtockt;oa,, CA 05206 { <br /> Ir�sby certify that the above named material has been accepted end to the best of,r4 k,riowledge the foregoing is true and accurate. <br /> +{ _ i•, r yh• fl ,r _`� '� f If4 y r>� lr ,r <br /> Name of AulhoriYed Agent Signature a .-. r Receipt Date <br />