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Waste � <br /> 9F1® � Acct . Na. i0090d2 NO <br /> Systems ,, <br /> 90GD25 <br /> B KING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • <br /> eneratorName M'd Cal Leasing 1649 E i,ti inne 1 St: <br /> Generating Location <br /> ddress A 0 Esc, 55 103 Stockton , Ca <br /> Address <br /> 1 Stcc kLon , Ca 9520IS <br /> Phone No EEEl— 4 6 0 <br /> Phone No <br /> �FI Waste Code C A 4 t3 9 1 6 E11= <br /> Containers Type <br /> Description of Waste Ouantit Units No Type D - Drum <br /> ll�asal C©ntam-inateci Sol I C-Carton <br /> 1 0 ❑I �J013 - Bag <br /> m T -"truck <br /> P - Pounds <br /> Y - Yards <br /> ❑ � ❑ O- Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper con ition for ransportation accor g to applicable regulations <br /> R-i t)art _- 41 <br /> 6�t-r'­Aulh.,,,;,�d Agent Name Signature <br /> Shipment Date <br /> IruckNo � ?)WW Phone No 9 1 b 668--9316 <br /> transporter Name M P E+i v e r nnn,%'an L a l Ser v t c;e��; <br /> Driver Name (PrintLa�L��� <br /> Address 3400 N o v o r S lr r^e e t i <br /> Vehicle License No/St <br /> at i <br />' <br /> 8QI1Qr-sf-ieIcl , Cc, 9 3 3 0 U <br /> Vehicle Certification <br /> I he=Signature <br /> amed material was picked up I hereby c tify that thea a named rjiateria! was delivered with- <br /> t the/ out incr t to the de i tion lisle ,below <br /> aver Shi mens Date � � <br /> P Driver Signature Delivery Date <br /> a ,y <br /> IiteNarneVaz `Q Road Sari tarry Landt i 1 l <br /> Phone No <br /> address 1 rill 1 Vasco Road , L-i ver more, Ca 94 550 1hereby certify that the above named material has been accepted and to the best of my knowle�dg0 going i 11 s true and accurate <br /> me of Authorized A ent <br /> 5i nature <br /> ecei t Date <br /> PASS CODE <br /> (y <br /> SF <br /> I260 72t] <br /> UNLOADING AREA COPY <br />