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' _ L .lh- <br /> p _ <br /> 0f ,,;, Waste No. 4 017 0 c" <br /> b f <br /> n ' Systems M NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> 13R0WNIt1G FEfiR1S MDUSIRIE5rdr 1 ?'j <br /> CCtt .rS?i,wri <br /> � s°�- :• ° 'r"_ _�.�> f 77. <br /> S <br /> Stut.lttn eLtit:x <br /> Generating Location <br /> Generator �`--- <br /> GU] [:. k;+tttic'r:itlit trattr. —� <br /> 5811 Address -- <br /> Address_— -- Lod I . G1 <br /> ��2�;��; 2D 0 GCt1 Phone No. <br /> Phone No. L�o �—_'-- -�— -- <br /> f Containers TYPQ <br /> D-Drum <br /> BF!Waste Codd t Quantit — Units No. C•Carrion <br /> Description of Waste <br /> 71q 6-Bag <br /> on 11"Izardutis 5011 frura T-Truck <br /> L,- tort of unders;round ❑ m ❑ P-Pounds <br /> !:rmrage funk Y-Yards <br /> ❑ ❑ Q-Other <br /> I hereby certify that the above namedmateriar 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 condition fqr transportation according to applicable regulations, <br /> Shipment Date <br /> Generotar Authorized Agen Nar.aE!j <br /> Signatu—pro - <br /> 415-634-68:30 <br /> Truck No. <br /> , Phone No. r <br /> Dillard Trucking, Inc. Driver Name(Print) <br /> Transparier Name ra <br /> P.O. Box 218 Vehicle License No./State <br /> Address <br /> Bron. California 945.14 Vehicle Certification <br /> t hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> }d <br /> at the generator site listed above, out ince an listed below. <br /> t to the desti <br /> (� r <br /> /)__yl)' <br /> shipment Date Driver signature <br /> Driver signature <br /> Site Name B-F•I. Vasco !toad Landfill -Phone No. <br /> ,1001 North Vasco Rd. . Lkverrnure, Ca. 94550 <br /> Address <br /> I hereby certify that the above named material has been accepted and to the bast.Of my knowI <br /> 77a the foregoing is true and accurate. <br /> r. <br /> Recei1 Data - <br /> Si - <br /> Na. .Authowed Anent <br /> J <br /> PASS CODE <br /> DF1260-720 - <br /> 10186 <br /> ••Tl!AH5P0111 Cit fiE'rAIN <br />