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+Fu <br /> rt" Piversal Environmental <br /> PO Boz 990 Benicia,CA 91510•Phone 707-7474M-Fax 707 747 1927 <br /> P.Q 6os 10120•Reno.NV 695t0-Pharie 775951-2500.Fax 775,351-1927 <br /> =Acr 0� 7 8 419 <br /> ,D# -A `62-) NON-HAZARDOI S SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name Generating Location <br /> Address —J1� ` / . Address .- <br /> t <br /> Phone No. — �`I Phone No L—I—U__F1 I <br /> Containers UDrum <br /> Description of Waste Qu Units No. an/tll7t7' !fiti 97Y� t ffr�t - //t G// u v 3 -S © ZFJJ 1 � s pp/ '%3/;�1 <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 /> 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 isjn proper condition for transportation according to applicable regulations <br /> t�t"•.,~a�'7P�Gl7�i-=i) t1�7`1rt�t� �-�'N''1 v ? I � o <br /> Generator AU oraed Agent Nama signature sm"ant Data <br /> TRANSPORTER <br /> 1;Truck No _ Phone ND <br /> Transporter Name/Z lfrh Vii,% ��`o ill•�1.7V�1I7 V'I/7L Driver Name(Print) <br /> -Address /�r f/� PL11 * /it/t/ -Vehicle License No/State <br /> Am/! <br /> %il l �l��i 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 /> } :7 ) r <br /> Drier 9gneturg ,. mipment DateDrWr signature Delivery Date <br /> DESTINA7101 G <br /> Site Name �1 r `1�. Phone No <br /> Address <br /> I hereby certify that the above named material has been accepted a d to the�basLg"�'''�knowledge the foregoing is true and accurate <br /> Names AUlh0(yZQd Agan - Si nature 1 Fimei Date <br />