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K <br /> Waste —__ — No -90 <br /> ' <br /> 026i �ct ~ L _ ltQ9Q' 4aSystems <br /> TMNON-HAZARD VSSPE ! LWASTE ANIFESTWNlNG RIs INDUSTRES <br /> 0 <br /> Cenerator Name Generating Location _ <br /> ddress Bax 55102 Address Stockton , Ca <br /> rw .3 t; <br />[hone No =—IPhone No =—IT= I f <br /> FI Waste Code y r a r, 1 9 Containers Type <br /> Description of Waste Quantity Units No Type D - Drum <br /> ❑ (� ❑ C -Carton <br /> Cir- -��)i -i�te�� C_ -7 ` J B bag <br />' ❑ �^ _ ❑ T -W ruck P - PPounds <br /> Y - Yards <br /> ❑ � ❑ O- Other <br /> 1 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 /> 1 ' <br /> nerator Authorized Agent Name Signature Shipment Date <br /> uck No Phone No 3 ' 5 5 F s3`h 3 1 6 <br /> Transporter Name t r" `-' ��t` `' `' ca- Driver Name (Print) �� / <br /> ' 410 i'13nc_, S ,,��t 30 <br /> dress i Vehicle License No /State Z�o / 5,2 <br /> ta,-ersf, eId (_a g?_0C L�;��._ <br /> Vehicle Certification <br /> ereby certify that the above named material was picked up I hereby certify that the above reamed material was delivered with- <br /> it the generator site listed above out incident to the destination listed below <br />!�I 'l )_� 112121 —ET:[:= <br />)river ignature Shipment Date Driver Signature Delivery Date <br /> Aw <br /> r s <br /> u r <br /> e Name VE-:co Poad wane tare- Landf-i -I I Phone No <br /> tC 1 <br /> dress `casco F'oac" L , ;�ralc<-e: - Ca 94550 <br /> ad <br /> lereby certify that the above named material has been accepted and to the best of my knowledge the foregoing Is true and accurate <br /> I <br /> Authorized Aent Signature Receipt Date <br /> PASS CODE <br /> 6 1l BF260 72D <br /> L IIERA OR P�:TA,Fj <br />