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Ft #3 0 �� 9 0 6-0 3S - <br /> y-i.w{14'�'t ,.x•-H t3�M��'�V�V�ti-s�-s-,� kx»�....�.» r --..ter Y. <br />[ROWNiNG-FERRISSystems Y"" NON-HAZARD r INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> j <br /> M d C 1' 64a E. Cha'ron,✓i y= <br /> "enerator Name Ge lerating Location <br /> A 0. Box 55103 Stockton ; Ca . <br />[ddress Address A « ^ <br /> tJ <br /> 'hone No Phone No �T <br /> �Ff Waste Cads 9 1 8 3 7 4 _I I <br /> - Containers Type <br /> IDescription of Waste Quantrt Units No Type D - Drum <br /> m El C Carton <br /> I ElZ' <br /> 8 - Bag <br /> I ` 7' Truck <br /> F� EE <br /> ❑ P - Pounds <br /> Y - Yards <br /> Elm F1 - Other" <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 conclitionj r transportation according to applicable regulations <br /> Ronald K _ Rinehart <br /> z !or Authorized Agent Name Signature Shipment Date <br /> uck No / Phone No <br /> ansporter Name M r kr, ,+ i r) eritnma-i Seg ` L e� Driver Name (Print) <br /> dress — 3400 Manor SCr=qt ' <br /> Vehicle License No/State <br /> Ba ke r s f i e l d Ca 9 3 3 0€ Vehicle Certification <br /> nereby certify thai 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']isted below i <br /> Iver Signat 1� Shipment Date er Sign re Delivery Date t <br /> fJ i <br /> DESTINATION <br /> e Name <br /> Vasco Road Sani terry La�ndfill � 4 7 D 1 <br /> Phdrie No <br /> i _ _ <br /> 4GC 1 vc75 3�Go : L 3�'�,�7ni L'+ 9455 <br /> Jdress <br />�reby certify that the above named material has been accepted and to the best of my knowledge the'foregoing is true and accurate <br /> �.luthorized A ent Si nature Receipt Date <br /> PASS CODE <br /> BFI260 720 <br /> 3EIbJEMATOR RETAIN <br />