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� .-..,SII.. "aaExms.��•�`T"w�`..' �., �. ..-�v�.,M..„.- ...�.h•...F - �.-.mow....,..... _��. .- .,�-�,r. � .� �� _ <br /> y37.e f . <br /> Waste No. 40172G <br /> Systems <br /> TM NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> 13rt0WNltiG FERRIS INDUSTRIES • _ a ^F; " fix' s +yzfrtf ', r " t a <br /> r;t11` <br /> •-;, ��su`,:.'-�:f+�`Y�c35y +•.. ;ll. station <br /> t;"cx':�f, �[:lrlcttttnt; ^� _ Generating Location —•--- <br /> Generator Name -- <br /> f', Address <br /> Address- Lodi, CA <br /> Stitt Sfat+o• Cn. 91.102 <br /> 3 G Phone No. �~ <br /> Phone No. i wt _�L�i—tEF—=] <br /> Conraisters Type <br /> l D.Drum <br /> �Quantity IL Units No. 7 pu C,carton <br /> pFl Waste Code L�—� descri alion o!Wasle -- t} r1 U i } it 0-Bag <br /> ---�- "-- T-Truck <br /> littzrlrlt,,,15 Sc,ll Crn"+ _ <br /> r.r-cuvat•iun of uudergro"J", El EE 1:1 Y Pounds <br /> ::LcrraF:e tant< T Y.yards <br /> O_Other <br /> as defined by 40 CPR Part 260.10 or any applicable <br /> ble <br /> I hereby certify that the above named material does �oO R Pant P6l to u d y applicable state law, has been properly described, <br /> state law, is not a hazardous waste as defined by applicable regulations. <br /> classified and packaged,and'!s in proper ondition taf transportation according to app' ' <br /> X. <br /> A. swpmont Dow <br /> Signature � . <br /> -oener^ awr A0j0rii(-,d Arrent NamC <br /> ` Phone No. <br /> Truck No. L�'f.i 0! <br /> �-. <br /> Dillard Trucking, Inc• Driver Name{Print} �� - <br /> Transporter Name <br /> P.(IiloK 21ti Vehicle License No,IState�—•---- <br /> Address ---�--!' <br /> 13yrnn, Galif+stria 9A5.1.3 Vehicle Certification <br /> picked up 1 hereby certify that the above named malerial was delivered with- <br /> I hereby certify that the above named material wasp out incident to the destination listed below. <br /> site listed abo e. <br /> at the generator,:-1•j � <br /> �, II ( vWw. Dago <br /> Driver signature �_ <br /> Shlpmenl Date <br /> Driver slgnalvna <br /> B.F.I. Vasco Road Landfill Phone No. <br /> Site Name ;forth iLivermore. Ca. <br /> ' , 001. �'ascc Rd. <br /> Addressnowledge tlte;ior)gGing is true and accurate. <br /> hereby certify that the above named material has been accepted and to the best of my. <br /> { i <br /> necei 1Date <br />_.-- ---- ._ ._.._...._.__ ...------... _...__....... ...------ ......--- ---.....-----------..._.. .__.._._... ..........._......... ........._......---.... .....__... --_....._.._... _......._.__..... ��.. '_-....----- ...._.....- ----------------- <br /> Si nature <br /> CI ,f Authorized A 9911 - - <br /> L. - PASS CODE ��— <br /> HFl280-720 <br /> tela6 <br /> TRANSPORTER RETAIN <br />