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R , <br />;OWNING-FERRIS <br /> 90-70QVVSystemsYM <br /> NON-HAZARDOUS INDUSTRIES SPECIAL WASTE MANIFEST <br /> • <br /> Mid Cal Leasing _ - ' 549 E C;,ar,nel St <br /> Jenerator Name Generating Location <br /> P 0 Box 55103 5toc1<tar, Ca <br />�ldress Address !n _ <br />■ `'* t<tr_r , Ca _ 95205 <br /> �� s 4 <br /> one No � Phone No <br /> I Waste Code I I=LJ Containers type Y <br /> Description of Waste Quandt Units No T pe ' Drum <br /> U-t eWel Contaminated Soil , iii � C -Carton <br /> B Bag r <br />' T -Truck <br /> ❑ m ❑ P - Pounds t, <br /> Y - Yards <br /> t Elm 1:1O Other ' <br /> _ + <br /> a <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 proper condition for tFansportatlon according{to applicable regulations <br /> 1 <br /> ?�na 1 :J <br /> f <br /> erator Authorized Agent Name Signature Shipment Date <br /> tick Na 4-T7 Phone No <br /> M P Cnvi rc,nmental Spry ice, <br /> nsporter Name Driver Name (Print) <br /> -111W, Manor <br /> dress Vehicle License No IS to <br /> Vehicle Certification <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> the generator site listed above out incident to the destination listed below <br /> Iver Signature` Shipment Date Driver Signa ire Delivery Date <br /> r <br /> DESTINATION <br /> f <br /> '/1-Co Pond� Sar-ii tar-\/ Land-fill Name I - _ I k J �— <br /> tsone No <br /> .1 }fit '�:i5i r� f+,r,ad L; vcarrYJrr'e <br /> +r-a _ 94 5er. <br /> idress <br /> r Ireby certify that the above named material has been accepted and to the h­st of my knowledge the foregoing Is true and accurate <br /> t , <br /> �.�A.jh.n rit Sr nature Recerot=Date <br /> IPASS CODE <br /> 6 BF1260 720 <br /> GENERATOR RETAIN <br />