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V f <br /> No <br /> a epi A+c�14 . iso. toa�na2 907995 <br /> bS,sl <br /> ems TM '° <br /> B ING+ER� INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> MidCal Leas-ing 1164 %:1b c[lar.)oel ;t <br /> nerator Name Generating Location <br /> dress Address <br /> N 0 flan 55103 St, cktun , (-cA <br /> d <br /> t)i 1- tc,n , Ca 95205 <br /> Phone No t' 3 6119 <br /> 0 Phone No FT <br /> tl Waste Code f A A 0 S 9 1 1= 1 i 7 4 rg I I Containers Type <br /> Description of Waste Quantic Units No T pe D- Drum <br /> C- Carton <br /> i.3 1 ese l Contain i noted Soil 81 El mL 1 B - Bag <br /> T -Truck <br /> ❑ E�.� ❑ P - Pounds <br /> Y - Yards <br /> ❑ �� ❑ 0- Other !I <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in prop i rc nd+tion f ransportati accor g to applicable regulations <br /> Zc „� 1 d K R 1 nel�a i'r <br /> r Authorized Agent Name Signature Shipment Date <br /> s • <br /> uck No o ` � Phone No 9 1 6 668 3 3 1 6 I <br /> ansporter Name Mp Env1 r©r-irr,eritaI Ser'✓ 1 c e= Driver Name (Print) <br /> Address 3400 N1a r 1 c)r Sr-1 t Vehicle License No/State <br /> ➢"" �~ <br /> 1 0 a 1,'�r f 7tn�1 d , C a 9 3 U f3 Vehicle Certific tion <br /> r <br /> hereby cert+ y that thea a named material was picked up I hereby ce tfy at the above named material was delivered with- <br /> the gne, tar site 1 e above _ out made the desti listed glow <br /> Iver Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Ite Name `4 a ;k:!Q Road Sar17 tart' L&ridtn 1 I Phone No c 1 4 l 0 d <br /> Address _ •1 ('C+ I Vds,co kc,ad , Live+- tnoi-e , Ca `i45`i0 <br /> 1j(j,)l)y , uriily owl thu ktbnve mmiud maloriai ha-, huun +tri ,rlNrnl nn,1 Io thu, hetil of my knowl*rdtle 1110 tareoitig is lrut+ and ti*{(urate <br /> ame of Authorized A enc Si nature Receipt Da e <br /> PASS CODE <br /> 0186 / BF1260 720 <br /> UNLOADING AREA COPY <br />