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` 'f+F � r • x _:. ':: u � a7' .�,•. .�• xfl;Y3 � — 'IXH'r <br /> f <br /> d <br />�t <br /> f Waste No. 4 o 1 f n 3 <br /> ' <br /> S y s t e r ns M NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> BnOWUING FERMS INDUSTRIES <br /> t',,Ut::1G Firtt ket�[ss; Generating Location <br /> C";UG1t. SU104.111 :tf, <br /> Generator Name <br /> • GO1 11;. F:=+!-t t srman Gnnc� ��— <br /> Address p. 0. [3ox `Ft 1 t Address <br /> Lod 1. G1 <br /> Sits strto. C3. 94402 <br /> L= <br /> _I—ail C f; Phone No. �^ <br /> Phone No. I—S �t�I Containers Type <br /> D•D+um <br /> f3Fl waste Code — Quantity- .� units. No. p c.Carton <br /> Description of Waste <br /> _�.. _� t r r l t' I 'I L�JJ r e-Bag <br /> Non fiit:'�7tdcus Soil from T•Truck <br /> Storage <br /> u[ und�r'gl uund E= ❑ � ❑ p-Pounds <br /> stus'uRc t.atsEt ���I I Y-Yards <br /> ❑ O.Other <br /> EU 1:1 <br /> rtify that the above named material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicable <br /> I hereby CO GFA Part 261 or any applicable state law, has been properly described, <br /> state law, is not a hazardous waste as dsfined by 40 <br /> classified and packaged, and is in prop condition for'r f sport <br /> ation according to applicable regulations. <br /> • .� � --�.� - Shipment Data <br /> Signalu e - <br /> Genewlar Authorized Agent Narne _ <br /> 415-634-6850 <br /> Phone No. j <br /> Truck No. <br /> ©illactf Trur•.ising, Inc. Driver Name(Print) <br /> Transporter Name " k <br /> Vehicle license No./State <br /> Address = j ' <br /> T'.0. flox 21G E <br /> li`rots. callfornia 94541 <br /> Vehicle Certification <br /> �^ I hereby certify that the above named material was delivered with- <br /> I hereby certify that ilia above named material was picked up <br /> out incident to the destination Fisted below. <br /> at the generator lila listed above. <br /> Delivery Date � <br /> ' Shipment Dale 'Driver signature <br /> Driver Signature <br /> Silo Name tl.F.1. Vstsro Road Landfill <br /> Phone No. <br /> 1001 `ort.it Vttsco Rd. . Livermore. CO. 94550 ! <br /> Address !� <br /> 1 hereby certify that the above named material has been accepted and to the best of my k� ledge lh foregoing is true and accurate. <br /> F <br /> J , / <br /> - ...._..---------- <br /> Signature � <br /> �— PA55 CODE <br /> BF1260.720 <br /> S` <br /> 10186 <br /> TRANSf Of1TEFi RETAIN <br />