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i Wasta 8F1 Asci . No. 1009042 No 907987 System TM NON-HAZARDOUS SPECIAL WASTE MANIFEST WNING-FERRIS INDUSTRIES • ' Mid Ca I Leasing 1619 E 01c2n11e1 5t= . � nerator Name Generating Location #� 0 UtJh 55103 Ccl dress . Address w t ilcl,t ori , Ca 95205 0 lone No 4 q — 5 5 � Phone No C A 9 1 2 O t 5 Containers Type I Waste Code Description of Waste Duantrt Units No T pe D - Drum C - Carton O i esel Contaminated Sall 18 �I m 7 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 10 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 prop nditton f transport i n acc ing to applicable regulations I d K R 1 nehd r� nerator Authorized Agent Name Signature Shipment Dale TRANSPORTER uck No . - A- Phone NO J 1 b 6 6 8-9 3 1 6 H P Ci iv 1 ronmen t a I Sei`\ i fransparter Name Driver Name (Print) TigsAr11c- dress s,,1 0 0 fel u n c i t r e e[ Vehicle License No/State OF Si in L• B-3k=i sf1eId , Cr 93308 Vehicle Certification lereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- it the generator site listed above out incl ent to the destination listed below nV er Signature Shipment Date er i nature Z Delivery Dale DESTINATION Site Name ciz,r'o Rodd Sanitary I...rai.dt i I 1 Phone No 1 fl _ 4 3 1 7 0 9 1 Ldress .100 1 Vasco Rc,ad L'i ,/errnore , Ca 911 550 hereby certify that the above named material has been accepted and to the best of�,rDyawl dge the foregoing is true and accurate t Aulhonzed Agent Signature Receipt Date PASS CODE 186 � BF1260 720 UNLOADING AREA COPY