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Nn <br /> ,, Waste _ ��� r-r-_r ,? Q - s� q 0 7 97 <br /> _- --- _ - - --- - - - - ��_ F - --- 3 - --'-�= <br /> Systems TM <br /> 0WWNINGFERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • <br /> F <br /> eneratar Name Mid Cal Le a s i riT _ Generating Location 1 64 9 E ha n n e S t <br /> i _ <br /> ddress P C ' Bax 55103 Address Stocl-tai, , Ca _ <br /> hone No'w ,- , 91-1 d 6 1 6 © 1 9 1 j - Phone No I - - r <br /> „ <br /> 1. <br /> 4 1 0 5 1 1 8 9 P 1 1 7 1 4 9 Containers Type <br /> 39 Waste Code <br /> Description of Waste Quantic t3 - Drum <br /> Units No T pe <br /> D m C Carton <br /> Q1es@7 �Gftt:cl-rtil�.c�r2f' <<73 i <br /> B Bag <br /> T Truck <br /> El <br /> P Pounds <br /> Y Yards! <br /> F m EJO- 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 condition for-transportation according to applicable regulations <br /> t <br /> nerator Authorized Agent Name Signature Shipment Date <br /> 0 <br /> k No LAIpS 7")O1 Phone No <br /> 1 <br /> ransporter Name M P Env i i~o�, er a I Se r v-1 c c—F Driver Name,(Print) <br /> k <br /> 1dress id 00 htak_or Et-, =- <br /> - - - - -Vehicle License No/State ' <br /> Vehicle Certification -~ <br /> lereby certify that the above named material was picked up 1 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 /> Iver Signa re v Shipment Date a, Driver Sagriature Delivery Date <br /> DESTINATION <br /> V , cco Qoa,l =nr9f; i <br /> e Name - - Phone No <br /> ' <br /> dress 0 3 1 Ca = r C <br />�ereby certify that the above named mater al has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> Authorized Agent Signature Receipt Date <br /> , <br /> i <br /> PASS CODE <br /> 6 i3F1260 72o <br /> ju <br /> GENERATOR RETAIN <br />