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Waste <br /> POWNING <br /> OFI Acct - No. 10109442 No 906035Systems TM FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name Mid Ccxl 16. 9 F Channel St <br /> Generating Location <br /> dress Box 55103 Sty-)C.kton , <br /> Address <br /> �i k.�ckt:un , Ca 95205 <br />'tone No =- 6' S 0 `I F-1 — <br /> Phone No <br /> Waste Code 1 A =t <br /> h - 1 fl e3 3 7 4 g <br /> Containers Type <br /> Descri tion of Waste Quantlt Units No T e D - Drum <br /> D1 ese 3 Gontatri-i t�ated Sol l C- Carton <br /> H Ij B - Bag <br /> ❑ m ❑ T -Truck <br /> P - Pounds <br /> Y - Yards <br /> ❑ m ❑ 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 taw, Is not a hazardous waste as defined by 40 FR Part-261 or any pphcable state law, has been properly described, <br /> classified and packaged, and Is to proper Eo dation fo tr sportatto cordin to applicable regulations <br /> IN�Jliald K R-ij)ehdt,t <br /> EI:T:= <br /> aerator Authorized Agent NameSi nature <br /> g Shipment Date <br /> • <br /> A <br /> I <br /> uck No l= `� `! Phone No 9 t 5 6 6 8 -9 3 1 6 <br /> Transporter Name M P Fn,rj ronrnental Scrv-t c e_-, <br /> Driver Name (Print) t� P4\,„ <br />[dress :x400 Mdr1C,r Street: <br /> Vehicle License No/State 114 <br /> Ca 93308 l <br /> � #- <br /> Vehicle Certification '1 tp m s _ <br /> lereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> it the generator site listed above ouLIncident to the destination listed below <br /> �t <br />)aver Signature Shipment Date Driver Signature <br /> Delivery Date <br /> DESTINATION <br /> to Name °' r-' Road �tai�i t3ry L�i-=uSt t 1 I 5 I { _ d 7 �� 4 4 <br /> Phone Na <br /> dress / 001 Vasco Road , Llverrnot,e , Ccj 94,350 <br /> I ereby certify that the above named material has been accepted and to the best of m '� ani <br /> y 45pnvuledge the foregoing Is true and accurate <br /> Ir <br /> uthorized Agent nature i Receipt Dat <br /> r PASS CODE <br /> dFl2&Q 720 <br /> U LOADING AREA COPY <br />