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PROWNING-I <br /> Waste----- --- -BFT-Acct , -Nog_ 1009042- --- ---_----- No -9079 $ 0Systems TMNONSHAZARDOUS SPECIAL WASTE MANIFE T <br /> =ERRIS INDUSTRIES <br /> • <br /> M'd Cal Lea,inch 1649 i=_ panne I St _ <br /> generator Name Generating Location <br /> P G Box 55103 S.ockton . Ca <br />�ddres5 Address <br /> ��t�4.1<tnt"1 r <br /> Ca - 252015 <br /> - 4 R q 0 R q A -1 - I I I F-17 I <br />[hone No Phone No �— <br /> FI Waste Cade <br /> Containers Type <br /> � � D- Drum <br /> � `I <br /> Description of Waste Qua nttt 1 S Un�lts No� �seCct <br /> np,rinatecf Soil f"W�� C -Carton <br /> T B - Bag <br /> f T - Truck <br /> �; ❑ W ❑ <br /> P - Pounds <br /> Y -Yards <br /> ❑ r`� ❑ O-Other <br /> � W <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 Gond€tion for;transport tion accA- <br /> nerator <br /> ing to applicable regulations <br /> Authorized Agent Name Signature a Shipment Date <br /> � � 15 ;5�a8-9315 <br /> luck No x � Phone Na <br /> 1~1 p Environmental Servescep r fjlj1/� rjG'X <br />"ransporter Name Driver Name (Print) ` <br /> ,0 Qr+ f��r- rar atr'��t �A �1��� <br /> dress Vehicle License No/State ' <br /> Vehicle Certification <br /> tereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> tt the generator site fisted above out Incident to he destinption listed below <br /> Z Z Z EHZ= <br />'river.Sigriature Shipment Date Driver Srg tura IF Delivery Date <br /> Vasco Phar <br /> Sanitary L:andfi l l 5 1 ri a <br /> to Name( tY ZC. 94550 <br /> 1 q C5 Phone No <br /> dress i 1.. �— <br /> 3 l a. cc F Vj L i verb€ o€^e C a - 94 5 0 <br /> d <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 /> jWA.=Zh.,,zed A ent SF nature Receipt Date <br /> PASS CODE <br /> 6 5F1260 0 <br /> GENERATOR RETAIN <br />