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, <br /> L: <br /> No. 4 Q 11-5 <br /> ' <br /> systems NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> •�• tM <br /> nr10wr71NG-rEnniS INDUSTRIES <br /> 11 <br /> I., y, �' f f,L.r,S. '4 <br /> T r t1L.tCPT, U at:irni E6013 <br /> L;I't t11E. rl,uLill _. Generating Location <br /> :generator Name _.------------y •� 601 I:. hctLLer.�ttn <br /> Address <br /> Address___ 1.0ai, CA <br /> r;col tlat.ro, U:., 911402 — _— <br /> 01 <br /> �! 5 ,-- 1 7 1 Z 3 C 8 Phone No. -- <br /> Phone No. __ ❑� Containers Type <br /> -T � —❑� '-.— �_ ❑�— - D-Dalt, <br /> BF-1 Waste Code ❑--.❑_� — - _Quanta Units No. Tye© <br /> Descrt tion o1 Waste Y_- C•Calton <br /> -- -- —T U U ❑1❑ `—� lt�l—.J L__1 E3•qag <br /> T•Truck <br /> l:c,It t:u7.�,rlk .;ell 0 p.Pounds <br /> (A ultr� <br /> r,'c'ktw%1LIGik c:f ryroutlt€ u <br /> :•;LUI:%!r:}0 t:GltiC Y-Yards <br /> _ — — ❑ ❑ ElC'Other <br /> certify that lho ahove named material doas not contain free liquid as defined by 40 CPR Pari 26D.tD or any applicable <br /> I hereby y �D CFrt Part 241 or any applicable slate law, has been properly described, <br /> slate labs, is not a hazardous waste as dolined by regulations. <br /> classified and packaged, and is in proper condition fa If nsp�talion according to appLcablo' reg <br /> r �� V <br /> Shipm'•nl[tale <br /> ir <br /> --'��•' d N5me Signature <br /> Germfarnr Authorized Ag <br /> r y �� • ,415-634--6050 <br /> ! Phone No. ^- <br /> Truck No. /f <br /> LUillara 'Trucking, lark• Driver Name(Print) <br /> Transporter Name 7 i r� C <br /> �--- <br /> 1?.(?• �l0 <br /> Address Vehicle License NO./State •> <br /> ornr, C.aliiot:nia 94544• VchicleCertification <br /> at the above named material was delivered with <br /> I hereby certify that the above named material was picked up, I hereby certify th <br /> out incident to the destination listed below. <br /> at the generator site fisted above, _ .:,; f :,, <br /> V[41pment Date Driver Signature <br /> Driver Signalura —III t I I plpl !III!'Ill I lig! <br /> a. 5 <br /> :,. 4 4 7 0 4 <br /> i3.F.i. V11,C0 Roac1 Gvadiill 50 home No. 4 l <br /> Site Name -- Liverrarer G7. 995 <br /> 4001 Dortla Va co id., <br /> - Address - ---- - ---- <br /> I hereby certify that the above named material has been accepted and tome best of my knowledge the foregoing is true accurate.-,-i <br /> necai r Date <br /> si <br /> Nan ,0mrized A not f <br /> ✓ PASS CODE <br /> artzso-azo <br /> telAG - <br /> TnAvisr RTE1 RETAIN <br />