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Waste BF1 Acct . No. 1009442 NO 946021 <br /> Systems TM <br /> IRQ W NING-FERA15 INDUSTRIES ES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Mid Cal Leasing 1649 F C fianne-1 St <br /> 3enerator Name Generating Location <br /> less <br /> M' 0 Box 55103 Address Stocl<ton , Ca <br /> at uchtort , Ca 95205 <br />'�ne No 2 0 5 1 3 6 I I —] Phone No <br /> C 14 1 G 1 9 1 X31 < n s 7 5 5 Containers Type <br /> Waste Code I l 1 � D- Drum <br /> Description of Waste Quandt Units No Type <br /> C Carton <br /> U iesel Containinated Soil 1 8 D m T B - Bag <br /> ❑ m ❑ T -Truck <br /> P - Pounds <br /> Y - Yards <br />' ❑ m ❑ Q-Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part L260�10 or any applicable <br /> state law, is not a hazardous waste as de ed by 40 CFR Part 261 or FVy applicable state law, has been properly described, <br />' classified and packaged, and 1s in proper or ditlon f transpor n ac r +ng to applicable regulations <br /> �iirlcr 1 �! h Ri neha r t �, j `�j <br /> r 1 <br /> .1 1414 1 <br /> orator Authorized Agent Name Signature Shipment Date <br /> w • <br /> hick No 4 Phone No y 16",+68- 9 3 16 <br /> ansporter Name 1�1 P Env 1 ronrrient c`a-1 Sir v-i cEs Driver Name (Punt&&4" U cry <br /> x•100 Manor bLr,eet va - �7 <br /> dress Vehicle License No/State <br /> " Ca 93308 Vehicle Certification <br /> Iereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> 3t tk1gerler for sit Iste above out i ent to the d tins#Ion listed below <br />}river Si nature Shipment Date ver Si ature Delivery Date <br /> DESTINATION <br /> ite Name :5'c'o Road San i tarsi-y Land fi� 1 l Phone No r 1 0 — 4 1 4 7 ) 9 1 <br /> Address "u01 Vasco ticyad , Livei r,iore C a 0•'1 :150 <br /> hereby certify that the above named material has been accepted and to the best of my_krsewledge the going is true and accurate <br /> f Authorized A ent Si nature Fleceipf Date <br /> )O Pass CODE <br /> 8F1260 720 <br /> UNLOADING AREA COPY <br /> I <br />