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F'ROWNING-FE <br /> aste_ _ _SFIAcct -No ___7 0030ti?� ___= No __90-7-975Systems TM <br /> RRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Mid Cal Lsasinc 1649 E_ Channe- l St . <br /> enerator Name Generating Location <br /> n 07 Box 55 i0 Stockton , Ca <br /> ddress Address <br /> . t,acktcr) . Ca . 95205 <br /> _ 1 3 5 0 _ <br /> hone No Phone No _ <br /> 31`I Waste Code 1 4 10 T ] [__.01._g I 1 8 f 2 1 3 1 7 4 5 Containers Type <br /> Description of Waste Quantity Units No MT <br /> D- Drum <br /> Di eye! Contaminated Soil C- Carton <br /> l 8 Edm B - Bag <br /> T -Truck <br /> ❑ m ❑ P - Pounds <br /> Y - Yards <br /> ❑ m ❑ O-Other <br /> hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 1010TJor any applicable <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applscable state law, has been properly described, <br />' classified and packaged, and 1s in proper condition for transportation ccordir�g to applicable regulations <br /> LA <br /> aerator Authorized Agent Namo Signature Shipment Date <br /> 1 r � ".J `4 r'�r,we � ...tY ,'... ri ry„r a ` Q � •J r t' �a in.- h�~�' �9f�y*Af�k'd+ �,��'° <br /> if <br /> i 6 666-9316 <br /> uck No Phone No <br /> M P Environmental Services <br /> ransporter Name Driver Name (Print) ' i` + <br /> dress <br /> 3400 Manor Street 2 <br /> Vehicle License No (State <br /> Vehicle Certification <br /> lereby certify that the above named material was picked up I hereby certify that the above named material was delivered wlth- <br /> t the generator site listed above out incident to the destination listed below <br /> 19 1 <br /> ave(Signature hip ent Date Dnve ignature Delivery Date <br /> i • � <br /> `J�sco Road Sanitary Landfill <br /> lie Name Phone No — <br /> I . Ors �`�sco Road L; ti r <br /> errrioe , Ca _ <br /> dress 94550 <br /> ereby certify that the above named material has been accepted and to the best of my knowledge the forenring is true and accurate <br /> Authorized A eat Si nature - Receipt Daie <br /> I _ <br /> PASS CODE _ <br />�6 OF1260 720 <br /> GENERATOR RETAIN <br />