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WFERRIS INDUSTRIES Waste f BFI Acct . NO. 1009042 No 907991 Systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST mid C a 1 Leasing Generator Name Generating Location t' G` Ildress How 55 1 (73 Address �:,t c�4 kt-c,ri , is 95205 tone A5 3 4 Q � L-1No Phone No I Waste Code ( A 4 Q Q 9 l ll 2 Containers Type Description of Waste Quant+t Units No T pe D Drum t t3 mC -Carton I Con taIli-t rlated 50-1 1B - Bag T Truck ❑ m ❑ P - Pounds Y -Yards ❑ El 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 nrproper�co d+tion fora nsportati actor l g to applicable regulations 1�.� r� . f�iehat enerator Authorized Agent Name Signature Shipment Date TRANSPORTER X31 b 663 -ys 1 b !truck No Phone No Transporter Name I'1 ri�` r nn+nen t a 1 >~v c�� Driver Name (Print) 2 r r Lddress 3.,t Q o Manor S t r tie t: Vehicle License No/State 7 S I'Z I;Like r s t i e l d , C'A 93308 Vehicle Certification fl hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- at the generator site listed above out incident to the destination listed below rove gnature Shipment Date DD liver Signature Delivery Date DESTINA,riON ► ard1t11 5 l 41 Site Narne --`_� ' 't -- -- ----T_ ---- Phone No _ — - —_ (Address 4 (10 1 Va ra f,C)ad , l IveI'riiC'�i' , l a 9A 'b11)0 hereby certify that the above named material has been accepted and to the best of my knowledge the foregoin is true and accurate} - - e of Authorzed A en[ Si nalureY Receipt Date • - • PASS CODE I10!66 BF1260 720 UNLOADING AREA COPY