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'gal. raj <br /> a q: F; 'I este No. 79 082 <br /> C <br /> k <br /> I y § Systems TM <br /> ' `o NON—HAZARDOUS SPECIAL WASTE MANIFEST <br /> .�NtI�E(3-FtGRRIS INDUSTRIES i <br /> GENERATOR <br /> a nk of ctocl:ton. ':,la l_i ft <br /> �tErn <br /> '{Generator Name Generating Location <br /> P. 0. Sox 1110 2430 w. El Dcaradc <br /> f Address Address <br /> t <br /> Stockton , Ca - 952C9 s toc t:tor , Ca - <br /> Phone <br /> C 9 _ 9 <br /> Phoria No. J Phone No. �- <br /> BFI Waste Code m <br /> 04 M Containers Type <br /> 4 <br /> ! <br /> Description of Waste Quantic Units No. T e D-Drum <br /> ! ❑ ❑❑ <br /> �cr5 niesl Cortam Hated Sc; 1 C C-Carton <br /> B - eag <br /> EE= Elm 1-1T -Truck <br /> P -Pounds <br /> Y-Yards <br /> ❑ m El0-Other <br /> f v. 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 properly described, <br /> classified and packaged, and is in proper oonditior�.for transporta ion according to applicable regulations. <br /> r <br /> Ronald K. Rinehart. <br /> i .'Generator Authorized Agent Name <br /> Ii g Signature Shipment Date , <br /> TRANSPORTER <br /> .,,Truck No. 91 S 5 t3 L'—?315 <br /> Phone No. <br /> "Transporter Name PEn v i r on tt an t a t Services <br /> n/ �_ )/� (rpp <br />� • } Driver Name (Print) I/L <br /> 3400 Manor Street <br /> Address- <br /> f._ Vehicle License No./State 61 - <br /> : Bakersfield , Ca e33ce V � 7 <br /> � Vehicle Certification � <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> �at thejgLte Ilsted above. out incident to the destination listed below. <br /> Driver Signature Shipment Date Dr€ver Signature <br /> Delivery Date <br /> DESTINATION <br /> Vasco Roaac Sanitary Land-fill. <br /> Site NamePhone No. <br /> Address 4001 Vasco Rand , Livermore , Ca . 54550 <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> N Authorized A eM SI natuie <br /> Receipt Date <br /> Age 2 a <br /> 1 �HF H <br /> 70/l38 ��1t"`���• PASS CODE <br /> at=i2ea72o <br /> TRANSPORTER RETAIN <br />