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I <br /> t1o• 4 01.7'13 <br /> Waste <br /> :. sY es'�M NON-HAZARDOUS SPECIAL WASTE MANIFEST �I <br /> 3HOW111'iG FFARISItdOUSTRIES m- <br /> + <br /> _ g 't',G. "fir` n - <br /> r� r,,1�:, ��.:a �----� ti'�t)r:Al, 4tatlen _t3ttf <br /> %1,trv,:t 1119 _ Generating Location <br /> aencrator Narrte__-- — - r361 17 f:f'tticst}tn Lunn <br /> f.St 1:c 5 t11 1 �_— — Address <br /> lddress Lull 1. C—A <br /> Mateo. tr1. i?a <br /> �ni t 6 __F2 i 7 'µ r' Phone No_ _� _ <br /> p_ Containers Tyl <br /> 'hanf,No• mm , r- ��� Q Qnun <br /> ^_ _Quandt _ Units No. Tyke G.Corton <br /> 3t 1 Waste Code —� pesCri ti +;astc_ _,�..�_._ —--- D f tt t:3-Bag ! <br /> T-Truck III <br /> l'arat•rof uSoil fr .l El � fJ P-Pounds <br /> r..:rati;,t[un of nderttround fJ y.Yards <br /> storage tank <br /> D-Dthar <br /> material dons not contain tree liquid as delined by 49 CFf� Part 269.10 or any applicable <br /> 1 tter—-.-eby I,fy that the above na+tted mate ined by �n t cn 0 l Part free <br /> or any app3icable slate lawn has been properly described, i <br /> stale law, is not a hazardous wastproper conition for transportation according to applicable regulations. <br /> classified and packaged, and is in proper <br /> w- , .• ` Shipmer l Date <br /> sig <br /> �- r trams <br /> ;eneratur Authorized e Y - <br /> , •115-G34-6fl50 <br /> Phone No. <br /> ruck No. r ,ee <br /> ckltsg, ���- / /✓//1/ ' <br /> W11ard TruInc. _ [)riverName(Print) <br /> Transporter Name <br /> P.O. E3oe Vehicle License No,/Slate <br /> address0 � -, c <br /> Byron. Callfr;rttia 94544VehicleGertitication <br /> {hereby certify that the above named material was delivered with- <br /> out incident to the destination listed below. <br /> hereby certify that the above named material was picked up f <br /> it the generator side/listed abovo. // �iY / U / lJ <br /> �� r.� Delivery Date <br /> Driver SVgnature ; <br /> (r�:�( ('l-'t� -- soipmentpate <br /> Irivor Skgnalure <br /> t>':r'G.�.. �� r '-� �+ ' ' ��1� i rs t ,1 s — 4 ; 7 D •1 9 1 <br /> f3,F.7. �'r,stu Road Landfill Phone No. !' <br /> Me N..me <br /> 4r}D1 Norttt 1'ttsco 4'+d. , Lfverutore. L'It. rJ•lS., �. <br /> tiddress y knowledge the foregoing is true and accurate. <br /> hereby certily that the above named material has been accepted and to the best Of'my <br /> necei t Date <br /> Si InEoulle —�— <br /> •nrired A ant <br /> PASS CODE t3F126�720 - <br /> OlSti <br /> ['mMSPORTER RETAIN <br /> r <br />