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_--13Pi, =Acer_ NO_ - inO9Oa - - No 9063 �-- ---=, <br /> YS �tis TM <br /> OWNING-FERRIS IND��IES^ NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> . r r <br /> enerator Name Generating Location <br /> P O Box t 5 1 03 - Stockton - Ca , f <br />[dress Address <br />[one No L Phone No �— <br /> I Waste Code O S 3 1 6 9 _ 7 C g Containers Type <br /> Description of Waste Quantity Units No Type D - Drum <br /> - Carton <br /> B <br /> - Bag <br />' T - Truck <br /> ❑ m P Pounds <br /> Y Yards <br /> ❑ m ❑ O - Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 GFR 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 c6ndition for trapsportatio according to applicable regulations ' <br /> itf iti _ R-ittcr7ar' t= � I <br />%elalllrjAuthorized Agent Name Signature Shipment Date <br /> Bim;. t p Ji +r^ i Y p21 <br /> wt <br /> i�tp�� � O i t rr? �9 <br /> cit No Phone No <br /> I <br /> nsporter Name Driver Name Print <br /> t <br /> + 30i! Pr1aoor' 'Stir eet 1 <br /> ress Vehicle License No(State <br /> Ce ?_330a i � <br /> Vehicle Certification __J �J�} <br /> 1�reby certify that the above named material was picked u 1 hereby cern that the above named material was delivered P p Y fy e ered with- <br /> the generator site listed above out incident to the destination listed below <br /> I <br /> 1� I ok I - <br /> ver Signature Shipment Dale Driver Signature Delivery Date f <br /> rIII, 0 + ® t <br /> i <br /> Name Froad Sanitary Landfill' <br /> - Phone No II <br /> 3 <br /> dress 1 7cc J ,1_r�, _ 4 i � r'r11Gyr'F' , Ca 94550 <br /> ireby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate f <br /> I <br /> P�A.tto eded Agent S, aature Receipt Date <br /> I <br /> PASS GODS <br /> 2P1260 720 <br /> GENERATOR RETAIN <br />