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MWaste ,AFI Acct - No_ 1009042 No 906039 Systems . . . WNING FERRIS INDUSTRIES Mo NON-HAZARDOUS SPECIAL WASTE MANIFEST Mid Cal Le.asirlg1E�rlJ E; _ enerator Name Generating Location � ress 0 Box 5b '103 Address 03 Stockton , Ca I 'rockton ' Co 9520b Ine 9 — 5 6 No Phone No C A q ) 0 9 1 � 2 3 7 5 Containers YVPe Waste Code D Drum Description of Waste Quantity Units No Type C - Carton U I �� I Cont.atnrtnated So-i l I f3 � El B - Bag ' ❑ T - Truck El 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 10 or any applicable state law, is not a hazardous waste as Ined by 40 CFR Part 261 or any placable state law, has been properly described, ' classlf�ed and packaged, and Is m propef�co dation forte nsport��accor Ing to applicable regulations i) l37 t 11 _ �tlllc3i't � � r 1 + 114 erWr AuthUnLed Ayunt Name Signature Shipment Dale TRANSPORTER luck No j ! Phone No 9 1 668-9 3 16 Transporter Name h1 F' Env i r on men t n I der vi c r Driver Name (Print) 71- [dress i`10 0 ria a' ,o r 7'1. I r Vehicle License No/State - ti v i e r s t 1.! , c am 9-,3 0 t, Vehicle Certification tereby certify that the above named materiel was picked up I hereby certify that the above named material was delivered with- at the gen rator site listed above out tncid sit to the destination listed b ?riv Si u` Shipment Date Driver ignalure Delivery Date ---------- DESTMATION Vjsca R05d Son i Lai-J, f-il l I E] — 4 7 0 1 ,:Ite Name Phone No Iddress 4001 Vosc o Road , E_ t vel'riiol e C_0 94 a50 Thereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate �W,l uthorized Agent Si nature Receipt Date ' o � PASS CODE —� )86 BF1260 720 0 �.._ UNLOADING AREA COPY