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---P <br /> V ��i 9Systems TMFERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> MM <br /> _ I <br /> F • <br /> 1 `Mid Cal Leasing 1649 1; : Channel Sc <br /> enerator Name Generating Location n <br /> Iddress <br /> P O. , Box 55103 Address Stockton CC- <br /> „E,L _ Ca . 3505 <br /> 4 6 5 01`9 - <br /> tone No Phone' <br /> No �— <br /> ;FI Waste Code 4 0 5 fl 1 f3 g 2 7 4 9 5 Containers Type <br /> Description of Waste Quantity Units No T pe C Crum <br /> i C-Carton <br /> Deese 1 Cont-aminated Soil 1 B Bag <br /> T -Truck <br />' ❑ El P - Pounds <br /> Y Yards <br /> O Other l <br /> j <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 2110 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-Iransportation ac cording to applicable regulations <br /> 5 <br /> nerator Authorized Agent Name &gnature t Shipment Date <br /> luckNo _— �" 6 / U __ Phone No 9 15 568-9315 <br /> f1 P Fnv r r r,=rer-�-� Sery-ces <br /> ransporter Name Driver Name (Print) <br /> dress _t r3` #'tar;o r 5 t r e=t r Y Vehicle License No/State <br /> Vehicle Certification <br /> ereby certify that the above named,material was picked up 1 hereby certify that the above named material was delivered with, j <br /> t the generator site listed above } out incident to the destination listed below <br /> i /A� I <br /> Iver Signal o Shipment Date Driver Signal ur Delivery Date <br /> DESTINATION <br /> ;ter„ t ='u '_w„df 1 i t L <br /> e Name - ” " Phone "Joy- <br /> I <br /> ''' i ' a cRoad . Live-mre 550ddreSs <br /> reby certify that the above named material has been accepted and to the best of -y knowledge the foregoing is true and accurate <br />■■ r j ' <br /> Authorized Agent Si nature Receipt Dase <br /> PASS CODE <br /> 6 BF1260 720 <br /> GENERATOR RETAIN <br />