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.d. <br /> 9S. <br /> a Waste 4 D 17 n 7 <br /> : E�5 �1`I <br /> r►nOW M NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> owr�IrJc•rr=ttnrs ItJnusrr�res <br /> .� ,qrr ''ref 4ey. F y rr�. j wl J1 r J. ,c. = { ;. <br /> "M <br /> .11 <br /> 1 wt... <br /> t...tr-.;[. "n[rr•tlrr� t'�;rlr.11. St.nr-Irrrr =r;Ot-, <br /> Generator Narrre __---- _ _ Generating Location_._------._--- _--�__ — <br /> P. 0. Box 5611 Address 001 P. 1,ytt lrrtau Lana <br /> Address — <br /> San Kato:o. Co. 01102 Lod I. CA <br /> Phone No. 1=51 <br /> l 1 _1=7 fff� 2 C, 8 Picone No. L—��� <br /> BFI Waste Code [-[-] ��� =F--= Containers TYPO <br /> Description of Waste — Quantity Units No, T © D-Drum <br /> 1 C-carton <br /> Of, q (t ] �' 0 g Bag <br /> Noll Illizal-dous Suil frurl <br /> ezcavraCion of uIlderground _ T•Truck <br /> sturat:e tallk ❑ ❑ P.Pounds <br /> Y•Yards <br /> ❑ � ❑ J-D[hur <br /> I hereby certify that the above named material does not contain tree liquid as defined by 40 CFR Part 260.10 or any applicable <br /> state law, is not a hazardous waste as defined by 40 CFn Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper cond.*on for transportation according to applicable regulations. <br /> Generator Aulhorixed Agept Na to Signalu:e / 1 Shipm 71e <br /> t <br /> .s7 Y 415--63.1-6850 <br /> Truck No. {' Phone No. I f <br /> Transporter Name <br /> Dillard Tr uciclug. Inc. Driver Name(Print) ---- <br /> Address P.O. Bo.i 218 Vehiile License No./Stale <br /> Byron. California 9.151-1 lW <br /> Vehicle Certification 106 >s C <br /> I hereby certifv that the above named material was picked up I hereby ce. �.y that the above named material was delivered with <br /> at the generator site Jisled above. out incident to ttae destinatiorr listed below. <br /> ��== - �r1' f%;�.�. / / t� � 1 .-��iu1�1 ' .C�er•..t,i:r._ !� f 1 r-� � l <br /> Driver Signature Shipment Dale oriver Signature Delivery Dare <br /> allf ♦ a. <br /> sCIax.Y <br /> Site Name 0•F.I. Vasre Road Landfill Phone No. '1 = — 'i t 7 0 4 9 1 <br /> 1001 North 'V'3SCo Rd.. Liverrtcrc. C.a. 91550 <br /> Address <br /> hereby certify that the above named material has been accepted and to the best of my k owledge th taregoing is true and accurate. <br /> — -- -- <br /> f- ------ _-.. P <br /> Hetet TDate <br /> FJ <br /> a, Aulherixed_Agent SfgnaWre — _�� <br /> PASS CODE <br /> ri]IrG 13ME.0.720 <br /> TRANSf ORTFR I-i1=TAII'l <br />