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t <br /> w Wte. IJ - <br /> I n r)9 0 <br /> Systems TM <br /> ROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • <br /> ' S4 g E C�ar-Inpl S t <br /> I -- ..Mid Cal Ueasing _ <br /> generator Name Generating Location <br /> Fr Q- Box 55103 Stoci-ton , Cs <br />'ddress , ` _ <br /> Address <br /> `t-ockton . l.? '5205 <br /> hone No , ,_,_ Phone No <br /> r <br /> A + <br /> F1 Waste Code Containers Type <br /> Description of Waste Quantity Units No T pe D - arum <br /> Diesel Contaminated Soil 1 ❑t� <br /> C - Carton <br /> B Bag <br />' m T - Truck <br /> El r_1 <br /> P - Pounds <br /> Y - Yards <br /> z U µ ElI� O'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 GFA 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 nrlalcr K R�n=har•C �� � , <br /> nerator Authorized Agent Name Signature shipment Date <br /> lu ck No ' [— l.._ __- 3 0 "E5 ...__.,_.,__ Phone No <br /> M P Env-i ^orimc-nt �l Ser <br /> ransporter Name Driver Name (Print) '!t•`1�� cf 'fl <br /> 3400 Manor .5treer <br /> dress °' ' - Vehicle t_icense No/State �- cr 6.0,' <br /> Y <br /> Vehicle Certification <br /> lereby certify that the above named material was plcke+d 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 /> . 44 <br /> 21 z C z z <br /> Iver Signature Shipment Date Driver Signature Delivery Date <br /> 1 • <br /> llasco Road <br /> lName _ �_' Phone No <br /> ddress <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 /> Authorized A ant Signature Receipt Date <br /> PASS CODE <br /> 6 BR260 720 <br /> t GENERAT01 RETAIN <br />