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` .� ..r,s pp nn CC J t� No. 79 "- '8 10 9 O .0ystens TM "uAZ1D V SPECIA LWASTE MANIFEST ,#TRRf$INDUSTRIES, ., GENERATOR t . ' Bank of , Stock r_ar Generator Na r me Generating Location - ? 'J . Pox 1110 a3D S. E Dcr a d c = - Address Address utnckton.• Ca . c,52,0 s ��o 1;ton , Phone No. Phone No. n f 7 M - ' r 4 Containers Type BFI;WtSt Code D- Drum 'Vi :'_� Descri tion of Waste Quanti Units No. Type _y. „ ❑ m C-'Bariort ..=ci � E B - Bag ' T -Truck mEl P - Pounds Y-Yards Elm D O-Other . I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicable state taw, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described classified and packaged, and is in proper condition for transportation according to applicable regulations. Ron&Id K. R1ne`3 C ! f Generator Authorized Agent Name Signature - Shipment Date TRANSPORTER �•,� � _ 31 S SSp-•031 5 Truck No. Phone No. •' ` !vl �''- Envi :^,onrro.nt�l 5ervic.s ��/J ��l-J'�/'/f�� Transporter Name Driver Name (Print) ✓✓/ 3400 Manor Street Address,- Vehicie License No./State �. Bakersfield,-C& . 8330°. 3C'c� �yj "Vehicle Certification 1 here y certify that the above named material was picked up I hereby certify that the above named.material was delivered with- t - erLeiatar sit isle above. out Jr4dent to the destination listed beO !r rivergnature.:_ i. Shipment Date. Driver Si§nature r Delivery Data - 13 DESTINATION • Vasco Riad Sanitary Landfill +' , Site Name Phone No. X001 Vasco Road . l_ivermmre , Com - 945cc0 ' Address 1 hereby certify that the above named material has been accepted and to the best of my knowledge the fore'goirig is true and accurate. A2 L2 I Authorized Agent signature `" Receipt Dale PASS CODE Moe BF1260.720 r - TRANSPORTER.RET* ,;