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w Waste- - :- _ -T - _ - - s - :0nnWMjNrG_rF.ERR[S - -- - -- W� ccC No . `, nr9lr,r � No Systems TM 1NDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST generator Name Wicf Gal Leasina 1549 F _ Ci-iar�nsl St Generating Location lddress P C1' Box 55103 Address Stockton , Ca a` r_kL _ 7 - Ca - 95205 'hone No 4 6 5 b 9 1 Phone No TI LTJ 4 tl 5 b aste Code E 8 9 2 7F4 3 5 Containers Type FI W Description of Waste Quanta Units No Type D Drum 17-i J m C- Carton esEl COriCc3rrll Hated Soil Ell B - Bag ' T - Truck I FT-1 ❑ m ❑ P - Pounds Y - Yards Elm 1:1O- Other I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for-transportation-ac cording to applicable regulations i ator Authorized Agent Name Signature Shipment Date . 0 - _41,10 0 ", luck No 9 16 568-9315 Phone No nsporter Name f`1 P Envi ronmerita l Serv,ces Driver Name (Print) dress 31n0 t1ar;o SCreci Vehicle License No/State . v Vehicle Certification [reby certify that the above named material was picked up I hereby certify that the above named material was delivered with- the generator site listed above i out incident to the destination listed below iver Slgnat a Shipment Date Driver Signator Delivery Date E ■ • Ie Name ` : C`, you _. te r, wary w.l�dfi l 7 ' Phone ^lo idress ' `'0 ' Va_�,co Road _ Livernore C& 91550 �reby certify that the above named material has been accepted and to the best of qy knowledge the foregoing Is true and accurate 8 _ EE:E= RAuthorized A ent Si nature Receipt Date IPASS CODF 6 HF1260 720 GENERATOR RETAIN