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ONING-' Waste 6F1 Acct . Hilo. 1009042 No906040 Systems TMNON-HAZARDOUS SPECIAL WASTE MANIFEST FERAtS INtIUSTRIES GENERATOR Mid Cal Le=asing V b49 L (Lanae l aL enerator Name Generating Location Box 55 103 Stot Mort Ca Ir ess Address " �_)Ckton , Ca - g5205 T] El Ine No 0 —1 l 5 _ _ 6 Phone No C A 0 1 9 1 2 3 1 9 5 Containers Type Waste Code D- Drum of Waste Quantit Units No Type C -Carton t t � aG1 (_ontcaniiniced Soi I m B - Bag ' T -Truck ❑ ❑ P - Pounds Y Yards ❑ ('� ❑ O- Other 1 hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260W10 or any applicable state law, is not a hazardous waste as defined by 40 CFR Part 261 or any a placable state law, has been properly described, ' classified and packaged, and is in proper cq ion for tr portatlon cordln to applicable regulations I5oiu Id I` R1 nethar t d L — � ' 2_ orator Authorized Agent Name Signature Shipment Date TRANSPORTER �ck No Phone No 9 1 6 6 6 8 -9 3 1 6 M ransporter Name h1 P Env-i rdnrnent-a I cervi ct--F Driver Name (Print) V ` 4,1 'dress 3,100 Manor, S r r'%_�e t- Vehicle License No/State ;' 7 `- l'a ke f t e I LI C d y 3 3 0 b Vehicle Certification �ereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- t the generator site listed above out incident to the destination listed below ez- 21 1 1 ?Tz nveT Signature Shipment Dale Driver ignature Delivery Date DESTINATION to Name'/ ca Road Sani taoy Latid f i 1 1 Phone No 5 _11a] 4T4 7 4 9 1 1-71 ddress ` 00.i Masco Poad , Livai,wore, Ca 94550 �ereby certify that the above named material has been accepted and to the bes#9 y knowledge the foregoing is true and accurate ,2 7 Authorized A ent Signature Receipt Date -��f_ (J �7) PASS CODE 7 13F1260 720 UNLOADING AREA COPY