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r <br /> Waste <br /> 9�1 Acer tto �oosoa2 0 907988 <br /> -Systems-TM_� _­ -_ _=y � _ <br /> iROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> 1 Cc19 enerator Name � <br /> Mid Cal Leas-Inc' Generating-Location <br /> _ - _ <br /> O. Bow 55103 <br /> ' JL Dc `_c)n C& 4 r <br />�ddress Address <br /> 5rorttton _ <br /> 95205 <br /> hone No [ <br /> r Phorie No1 -4 <br /> 4 fl 5Containers Type, <br /> 39 Waste Code D - Drum <br /> Description of Waste Quantity Units No T pe <br /> m <br /> Diesel C.ontamnnated So, ' C - Carton <br /> i ❑1 <br /> B - Bag <br /> ❑ m ❑ T -Truck <br /> P - Pounds <br /> Y - Yards <br /> _ : � <br /> y, - - 77 1 mk� 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 CFR Part 261 or any applicable state law, has been properly described, <br />' classified and packaged, and is in proper condition for-transportat on according to applicable regulations <br /> t:c+nald K R inel•7art J `r <br /> J J <br /> nerator Authorized Agent Name Signature Shipment Date <br /> 0 <br /> i <br /> f' J J 9 3 I J <br />�uck No a U Phone No _ <br /> N1 P t_nvironn)ent.�l Service=- <br /> i ransporter Name Driver Name (Print) f . /50 �N �- <br /> 100 M=sn")r Sta'G-et <br />[dress - - Vehicle License No/State <br /> Vehicle Certification <br /> lereby certify that thq above named material was picked up I hereby certify that the above named material was delivered with <br /> It the generator site ted above out Incider)t to the destination listed below <br />)river Signature Shipment Date Driver Srg ature /Delivery Date <br /> DESTINATION <br /> to Name Jasco Roach Sanitary Land'f�i l l i 0 - <br /> Phone No <br /> ddress `100 i Vasc'�`> 'Roe,! Li verrore? Ca 3«5c0 <br />% ereby certify that the above named material has been accepted and to the best of my kn „+vledge the foregoing is true and accurate <br /> Authorized A ent Signature Receim Date <br /> li PA GODS <br /> as oc'250 720 <br /> GENERATOR RETAIN <br />