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Waste <br /> ACC:z —" om _wrr �� ?' ? — - _ —tJo- n Q -Q Q <br /> 6 <br /> T#iSystemsPROWNING <br /> FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> - Mid Cal Lem-" n9 1 649 F_ Ct�arinel St . <br /> generator Name Generating Location <br /> P . 0 . Box 55103 Stockton , Ca <br />�ddress Address <br /> Stockton , Cay 95205 <br />[hone No =_I <br /> Phone No <br /> Ff Waste Code Containers Type <br /> p Drum <br /> Description of Waste Quandt C Carton <br /> Diesel Gontarn7nUte"d So"I t ' u, <br /> B - Bag <br />' ❑ T Truck F_] P - Pounds <br /> Y - Yards <br /> Elm El Other` <br /> I hereby certify that the above named material does not contain free liquid as defined b 40 CFR Part 260 10 or an applicable <br /> Y Y pP <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'fr`apsportation^accordiri to applicable regulations <br /> r-_,,5 ' <br /> 1d K P-ir�ehar �L <br /> jene,alor Authorized Agent Name Signature Shipment Date <br /> 0 <br /> ruck No _ �_ " { Phone No <br /> M P EnvironmentalService!:'Service <br /> ransporter Name Driver Name (Print) <br /> {n 00 t"ant r <br /> ddress _ Vehicle License No/State <br /> Vehicle Certification <br /> kereby certify that the above named material was picked up I hereby certify that the above named material was delivered with <br />.t the generator site listed above out incident to the destination listed below <br /> r gnature Shipment Date r gnature Delivery Date <br /> DESTINATION <br />� <br /> t Name <br /> Vacn Po_ t S a n i rare Lan d f i l l/�r� 1 Phone No <br /> 4001 `/a_- RC�n rf Llv=r mo & C Q,' cti r) <br />+ddress <br />�ereby certify that the abo, a named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> of Authorized Agent Signature Receipt Date <br /> PASS CODE <br /> 1S6 BF1260 720 <br /> GENERATOR RETAIN <br />