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WasteWaste 907990 <br /> . . 0 6�I Acct _ Wo_ 1Ob90b2 No <br /> Systems TM <br /> ROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Midcol Lecas tr1�,3 1 a49 E r;l�ari, ,E.l 'ter <br />,eirato, Name Generating Location <br /> r' 0 Ba.c 55 103 C� <br /> ress Address <br /> �t ,�14tor Ca 95205 <br /> t..._�^ 4 5 <br /> hone No Phone NoF-T <br /> A '3 1 3 1 9 3 7, 4Containers Type <br />'Waste Code ` D Drum <br /> Description of Waste Quantity Units No Tempe <br /> � t� 1 Cpi�Larri�s�atd 5t,i1 m I qI C - Carton <br /> u l3 - Bag <br /> ❑ m ❑ T -Truck <br /> P - Pounds <br /> Y - Yards <br /> ❑ F1 - Other <br /> I hereby certify that the above named material does not contain free liquidas defined by 40 CPR Part 260 10 or any applicable <br />' state law, is not a hazardous waste as de coed by 40 CR Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in propeq cc clitionfr nsporta o ccor i g to applicable regulations <br /> Pinehat't 1 <br /> hr uthorized Agent Name Signature Shipment Date <br /> ti • h <br /> Ilk No LA`iZ1_A ° tr Phone No 9 1 6 b brt -c$'3 1 b <br /> orter Name NI <br /> sP Env7rc�++ritrlta � Sri v� c �� <br /> p Driver Name (Print) <br /> dress w _ItiQ Mafia-r ._:'t-i eat _ <br /> Vehicle License No(State � <br /> Ib,-j I.t-_r s f-i z t d , ( a 93308 Vehicle Certification <br /> ereby certify that the above named material was picked up I hereby cgrtify that the above named material was delivered with- <br /> he generator site listed above out incident to the destination listed below <br />/er Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Name vI co Road S;ani Cary Londf ­l VI 1 <br /> Phone No <br /> dress 1 110 I Vasco Rc-,ad , Li ver more . Ga 94 550 <br /> � r _ <br /> Ireby certify that the above named material has been accepted and to the best of my knowledge jDregemg is true and accurate <br /> uthor¢ed A ent <br /> Sinature aceipt Date <br /> r a PASS CODE <br /> 6FI26o 724 <br /> UNLOADING AREA COPY <br />