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1 o I J FERRIS INDUSTRIES Waste BFT Acct _ No. 1009042 No 906038 Systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST OWNING- GENERATOR Mid Cal Leasing 1 t 4 LI E t heitirte l L. Generator Name Generating Location r` (i Box �rJ' t [�3 Wit:�c.l.t=on L a dress Address r-cl,t c)n , (',� _ 35205 0 3 3 6 tone No 5 Phone No [--74 4 1 1 1 O g 1 1 2 1 -1 ? f 1 5 1 1 Containers Type Waste Code 1 1 D - Drum Description of Waste Ouanttt T Units No pe C - Carton nisei Cant�,rntt7ated Sn71 1 8 ❑1 m T B - Bag T - Truck ❑ m ❑ P - Pounds Y - Yards ❑ m ❑ O- Other I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 1100 or any applicable state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, ' classified and packaged, and is In proper 17dation fort asportation ccordtng applicable regulations k< j cl Id I% Rinehat t_ CT` � [CIL- 1!�A aerator Authorized Agent Name Signature Shipment Date TRANSPORTER 'ruck No !��f _... .. _.._..,.,.,...,. ,...._.___.._ .--- Phone No 916 1568 -93115 M P Et�v-troninenca1 Services Transporter Name Driver Name (Print) �T k4 r✓S Iddress 3400 Ma r),D r- S r-t ee t Vehicle License No/State ` G (' 4 . 9 3.3 0 b Vehicle Certification hereby certify that the above named material was picked up I hereby certify that the above earned material was delivered with- at the generator site listed above ou r cldent to the destination listed below rtver Signature + Shipment Date Driver Signature Delivery Date DESTINATION San i to ry Land t i i 1 5 1 U —F4] 4 7 41. 9 1 Site Name Phone No Iddress t 00 l V=sco Road , LI verrrtcr e , C u 01 550 I r hereby certify that the above named material has been accepted and to the best of m knowledge regoing is true and accurate Adak r I Authorized Agent / Signature Receipt pate PASS CODE 10/66 ,-2,� 8F1260 720 UNLOADING AREA COPY