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PROWNING-IFERRIS <br /> �aste` r� —_ 9 Q 9.7=t! V _Systems TM <br /> INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> i <br /> 1 <br /> - Mid Cal Lecrsa nq - N 1649 E =h.3nnel St . <br /> enerator Name Generating Location <br /> P ter- Box 55103 Stockton , Ca <br />'ddress Address _ <br /> t i <br />'hone No Phone No�� <br /> FI Waste Code r- 0 3 1 9 2 3 i 9 S Containers Type <br /> Description of Waste Quantity UnitsNo T pe D _ Drum <br /> 1 0C- Carton <br /> D-iesel , Contarn i riaCed _o-; I 1 8 m T B - Bag <br /> T -Truck <br /> ❑ ❑ P - Pounds <br /> Y - Yards <br /> ElO- Other - <br /> hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 26D 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 transporlatio ,according to applicable regulations <br /> r 4 <br /> c, ?nalo Pnrneh,ar,t= > > t <br /> nerator Authorized Agent Name Signature Shipment Date <br /> 0 <br /> uck No Phone No-� 6 -93 <br /> MP Environmental mer v� c <br /> ransporter Name Driver Name (Print) '`� }1,, -,) ),'�1 <br /> a L 0, Maooi Str eet <br />[dress-=' ";^ - Vehicle License No/State __.. ! G t(.;1 <br /> Vehicle Certification <br /> ereby 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 /> I fy <br /> \ \ ` I <br /> 1� -k ci 2 � � Z Z t <br /> Iver Signature 4 Shipment Date (Driver Signature Delivery Date <br /> DESTINATION <br /> �a <br /> 1f,� �rr1 �Cra C4 ` �r� f '.''. iC � n i <br /> n 3t. ,i l' <br />�e Name l?hone.No <br /> , <br /> ddress -` <br />�ereby certify that the above named material has been accepted and to the best of my knowledge the foreigoing is true and accurate <br /> v , <br /> ELI I I L <br /> Authorized A ent Si nature Receipt Date <br /> t <br /> PASS CODE <br /> t <br /> 6 BF1260 720 <br /> GENERATOR RETAIN <br />