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z <br /> w <br /> Waste---- ---- ----- -_ -Acct y� _ 1009 <br /> �/��9 �No s o s o_44 o- <br /> Systems TM 'PROWNING-IFERMS <br /> _INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • 1 A <br /> F -7,_ 164g- t= _ Ch-rInel - Y <br /> enerator Name `� �a `` �- �� at <br /> gGenerating '_ocation- <br /> ddress Address St <br /> P C Box 55103 Stockton , Ca`_ = - <br />� _ - <br /> 51:0rL-to - <br /> 'hone No =—� I -- Phone No — <br /> FI Waste Code t, 0 9 1 2 11 3 7 J1, 1 5 1 1 Containers Type <br /> Description of Waste Quantity Units No Type D - Drum <br /> C - Carton <br /> Diesel Coi7t�rr, Ir�tGd 3c,j _I P ! B - Bag <br /> T -Truck <br /> F] F-] P Pounds <br /> Y Yards <br /> �{� ❑ � ❑ 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 trartatlon ccordln to applicable regulations <br /> ( II <br /> Ronald K_ Rinehart <br /> nerator Authorized Agent Name Signature " Shipment Date <br /> e.yp a' 4* <br /> uck No >� Z � Phone No <br /> 916 668-9316 <br /> t � <br /> ransporter Name M P Er,'v i ­ontni-r i t:a I 'er--ices Driver Name (Print) ¢L�/ <br />[dress 2"0 r Manor S t r,es t - Vehicle License No/State 2 -5.7 75-2- 7 <br /> £� ke r s f e l o _ C 9 3 3© S Vehicle Certification <br /> tereby <br /> 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 /> rover Signature Shipment Date Driver Signature Delivery Date <br /> e Name5co Roam Sant t ary- t anc11 l 1 Phone No } 0 — 414 7 9 1� <br /> - - I <br /> dress 4 001 Vasco Rozzc , ?-t �wl'r:ior � t,a 94550 - <br />�ereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> l <br /> Authorized A q e n t Si nature Receipl Date <br /> PASS CODE <br /> I <br /> 6 BF1260 720 <br /> GE1N'wr-'Vr0-- RETAIN <br />