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dVte rs No 798028
<br /> f TM ,
<br /> ,� -� ° NON-HAZARDQYUS SPECfALwWASTE MANIFEST
<br /> JIG-FERRIS
<br /> INDUSTRIES�V ,� s
<br /> GENERATOR '44
<br /> r k a r"�Stockt ri�.,–; • " ' � ' ` sabka Oistributing
<br /> Generator Name Y' Generating Location -
<br /> 1149 W-',Weber
<br /> Address Address '
<br /> - StaCktOn�;7 •Ca- 95209 _ r Stockton , Ca -
<br /> Phone
<br /> a -
<br /> Phone No d 9 — j 1 1 3 _
<br /> Phone No
<br /> BFI Waste Code C A 4 0 Q 6 Q 2 3Containers Type
<br /> Description of Waste - Quant i Units No Tie D- Drum
<br /> Diesel Contaminated Soil - g m I I C-Carton
<br /> J B - Bag
<br /> E El P-
<br /> -Truck
<br /> FTI P- rounds
<br /> Y-Yards
<br /> _ - ❑ m ❑ O-Other
<br /> LI 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 defr� by 40 CFR Part 261 or any applicable state law, has been properly described,
<br /> classified and packaged, and is in proper wndit on four Er nsportaii ccor ing to applicable regulations.
<br />' Ronald K�r Rir►ehaA _ �- t/ {
<br /> rr
<br /> Generator Authorized Agent Nemo ; ; +,~_ i.;�s signature: •- ,t M1 - •�� t r-t, Shipment Dais —TRANSPORTER -
<br /> Truck6/
<br /> Phone No: _
<br /> � 7�.�db+���i�`�,'``�^ � L/'�, �«�-�-Y��v'�L'f-"�,if 4'."x+Ari"R.ter,.-�tis"'Y_r`e ry-ty�ey.�,a�;ty���.�fi-i`r ��� •�`�`..�-.T'�, �Y,'r,�– � t y 't: t
<br /> Y r � �+lP» €nvironmenta ,,Servicas �.
<br /> Transporter Name • f r - - y• }Driver jiame (Prii,t) Vis/� 7
<br /> � , `�"�!li'/�rt.>�• �� �y�� '�'b ,L"'�" ,re1+�p�C'i.��3rG� } '�„+r'ax rr�.y -e'`�+�k:�+�.�`,?'T.,,,�.`.p,,:r v,��i.,..�x�
<br /> y3,4QQ�MaiiO�itSt.re@ �'� .. � ��t+ � �W;�
<br /> Address Vehicle License NaJState Iq��
<br /> s� r• /,z ••F"xaJ.�i ` }a. [ � �a`K a` �,'�.,���.� �.� � c} �- "'ai"" �i�i.,.�r a"'.r,.�t�C,r.e
<br /> `+Vehicle Certifcaban � '�
<br /> �� �'��: a��G�'�'�'�.�}'�7 "=�",��"L'a,.i.- .��.���$+ �.,��i.� :i �L+�` +.A a i' +' ,�'"W�lr.•,� 'A;„,. .yam... ...,�
<br /> r#.�.y,.� �•'� �3.f' v-. . Vi.µ.yts.:.
<br /> I here!Vj certify that the above.rtamed material was picked up" I hereby certify that the above named material was delivered with-
<br /> at the generator site lista `above. �� out lricidetit to the destination listed_tielow..4;
<br /> * �� / � �/f � r �s i r�` � *�R TMv�,' "f3 tib" 1�C+..'1.-ws q�'� p 1.'� ,�},» •� �C '�
<br /> 4-
<br /> Djffw Signet Shipment pate DrHer Signature • tisr�sw,q� ,� y ti §� Delivery Date mow► d
<br /> •}v. �� 'gtr."r�f4 w ��,yi+''�+sJ''�x r�3,y'��� `�,>�,�� �d:�;�`'h� }
<br /> DESTINATION
<br /> acfl�Roadar of f° �`` r ` _ " . a r_d ,�9 1
<br /> Site Name-y - - r.�,' �` = Phone No• " " "'
<br /> y" `'� �- T s ps �a ] ��Jj•'��'�: -
<br /> Address-d Ot]i V�as �d�.-ivemor®,xCs� s9455tT' , �s� v'i,,; r�.�3'- �,� ��,:,- -y^;w.;` •,,: ,r
<br /> - x .. .� r_cLt r- �� i-h,...s r.�r� . a^ _ _ �',f �r:: 1' `.- :".� ' rf
<br /> 1 hereby certify that the above named matena[ has been accepted and to the best o owls a the foregoing is true and accurate.
<br /> - -
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<br /> Authorized entC+�x {, •. y:3 n1 Si nature �r ss Re D 9
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<br /> M1J i "+'fir �^K �' � �,, t+f-" PASS CODE .. -
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