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dste No 79801 .1
<br /> �yste,ms
<br /> :!CG ffRR1SINDUSTRIES�' r�1i NON-HAZARDOUS'SPECIAL WASTE ,MANIFEST
<br /> GENERATOR
<br /> ..gy�pp rr
<br /> +:"' � ' ' �,c i F�`.rr `i 7 .m {• ' l✓ bKa .0i5t'r' I]t]'tingY s,
<br /> l Y F ;,'} B k" of Stocjctan a _: _. Generating Location
<br /> Generator Name -
<br /> � Q . Bax y111t3 - ` 1143 '.J. Weber
<br />' Address Address
<br /> - S,-)cktan, Ca _ 95202 " S'tocktanr Ca . ,
<br /> 71.
<br /> " � 9 — 9 4 ' 3 7 5
<br /> Phone No L Phone No
<br /> r t 0 5 C g _ a Containers Type
<br /> BFI Waste Code � D- Drum
<br />'
<br /> Description of Waste Quant1ty Units No T e
<br /> ❑ m C-Carton
<br /> Diasel Contaminated sail 1 u g- bag
<br /> I ElI�.J ElT Truck
<br /> P - Pounds
<br /> Y Yards
<br /> LJ
<br /> ❑ ❑ 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 /> state law, is not a Hazardous waste as defned by 40 CFR Part 261 or anyj applicable state law, has been properly described,
<br /> { classified and packaged, and is in propet<co ditton foTansportatt n accords g to applicable regulations.
<br /> _ Ronald IS. 'Rinehart O
<br /> C3eneTRANSPORTER rotor Auftrized Agent Names em { — Signature r - * Shipment Date -4—A `�
<br /> .
<br /> � � '^ff�� t.. tr �•.f�w:_:.3 �?tiN i ire ,.� .rm '. � «` � �scy�' '�,-?
<br /> Truck No
<br /> !`_ "�=?3, �°•.�"i;}�z��P�En�ir�nrnentAS6rY�C�S' ,��<`C'r�+=`"'�g._�`� , �r��f YV r �'�7',,��
<br /> Transporter Name`°"� - Driver Name(Print)_ �`r �r
<br /> ,y� 4 - ��� 1`�r+'�^'r>>�+r !yrFti�Nj 7 y.�v.f-s •r Y��M"',f-�,�f.t.. ��.�h�J� w.��.',ji� ,vJ�'--�" •Jr_a /r��5ss -i;�/+�Cs/^��-�„4�,
<br /> ♦ Y., i ,7N a*�+•4-"+�Fi-�.� .rr L'" St ..wk. Y"�i: h."'!x �'rp�`5T ��'��A'.•/�� /} �V C..� i r�
<br /> &ddress 3400X IartarrtStreet�..; ,. t• S'yi r: 5
<br /> I Vehicle License No./State I ----- -
<br /> � � �. . ��°.a�"+.'�w �,
<br /> - g
<br /> • Vehicle Certififcation `�"•" ''`
<br /> iyt^��S'} `�ew��p'*r��af�'�r w.+`.+,.�``ti�Tfrr d'��'.�,�'r-Ec-6'„�.-+rc,�r¢,�'�Sr;�•^�
<br /> Ihereby certify that the,�a�amed�material was picked up.,�r�� i herebjr certify that the above named material was delivered�wtth-
<br /> at the generator sde bsteti-abo a �� : ' '�"� �'~';out Incident to the destination fisted beiovY �
<br /> _y�r...r ? is
<br /> �' �5 • 4fxT '����� � r�'�r', _ � c�}`�".,'e��'{��'��=fi'�'^ �� " rt. _..�.^�6.-�•�a';� "+�ri �-, � �`�aUtra - Y' Shipment Date ;x,:._ gr Sig weir -r + ;sbr'+ fi4cat'�* "rDel ry�Date,lam
<br /> '► W1. ? �lr �� ` rta'r i�r 'i f ,.a'��+:r".�rtirµ
<br /> DESTINATI
<br /> I �~ .r ` ',efnfsa+ �, Yr. L y=1�,+;•ir'1�as'� s �*� «'w -
<br /> !' V�$S`CO I;OSdi S'a itar'y+` "Land 11'114j,
<br /> `Y i cxY"1c 4 0,
<br /> Site Name � - ' _ Phone No. =
<br /> c"Xp. i. f.;..r.��r �- ,5 " } rh.R„t, r=^ter—'�. r w t•[`� ',gyp
<br /> = � !t4 s "� r! f
<br /> I -�"-' ,40i31;.-Vasgx3j, 2oad7, , LIVarmare :, Ca� r� 3d5�tF-
<br /> Address g �
<br /> � K� �' �,acS
<br /> I hereby certify, 1
<br /> t� that the above named material has been accepted and to the best of my kno ,Iedg a foregoing is true and accurate
<br /> .. t`' s -
<br /> 3h2
<br /> �7; ;'
<br /> c
<br /> Authorized Agentti ` r a ' Signature " a Recer Date
<br /> r1y � 4%i_JJaH w •- M
<br /> or
<br /> 0r
<br /> :
<br /> -
<br /> Ir .1
<br /> ` "R-- q '-� .}}! s•- ci jZ„kr -rr`�`>t' ti , _�- ` '” *�^ ?ASS CODE
<br /> �, ,,.� ±" � rt��^ s.' rsw rte. .C... •w i l��- .�j'.. , " a ; ;-r `�"d n Y r.�, � i r
<br /> www Y. :a•", `� elr ���r^r'`-'♦ri .t.:�� �:_a''� },,.:.�w��.�+y ;r i /ti �"!'r,.t -.' r �. :.1?�L-= r_'-+ 'r l- 6F12W720
<br /> All
<br /> +
<br /> TRANSPORTER RETAIN
<br /> 5
<br /> r
<br />
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