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PROWNING-FERRIS <br /> Waste-- - - - GcruL� .�� � � 9L7a - —No 9798 Systems TM <br /> INQUSTRlES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> M-id Cal I_ecsing 1649 E . Channel St <br /> enerator Name Generating Location <br /> P n Ro, 55103 Stockton Ca - <br />�ddress Address <br /> �• Ca - 9520S <br /> 'hone No =-14 3 1 11 ILI t T] _ Phone No — 1 _ <br /> FI Waste Code C A 4 s3 0 9 1 1 8 I I 3 1 7 4 T 51 1 <br /> I I Containers Type <br /> Description of Waste Quanttt Units No Type D - Drum <br /> C- Carton <br /> rize�r l roncaminated Soil Ll I ' gEl T B - Bag <br /> T - Truck <br /> ❑ m ❑ <br /> P - Pounds <br /> Y- Yards <br /> ❑ m F-10- 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 properrdondition for transporta +on acco ding to applicable regulations <br /> R-inehar,t P� � - <br /> fl <br /> nerator Authorized Agent Name Signature Shipment Date <br /> y� <br /> r�r �M '1-"r <br /> -�-- 916 668--9316 <br /> tuck No Phone No <br /> grans orter Name h1 P Ertvi -or,tn�i-ttal Se-vices <br /> p Driver Name (Print) <br /> dress �� �- <br /> Vehicle License No/State <br /> o ' n <br /> Vehicle Certification <br /> lereby certify that the above named matertal was picked up I hereby certify that the above named material was delivered with <br /> I the generator site listed above out incident to the destination listed below <br /> i <br /> r <br /> riv4eS naure Shipment Date r tg ature Delivery pate <br /> fi' <br /> =t� �rl t_ sCJ <br /> y "t i � t4 rl 1t- <br /> 1. <br /> r <br /> e Name -- i Phone No �— 1 <br /> 1dr , - , • \ CJ =cC Ll \r:rm:: re C,a C µ.4 <br /> d ess <br /> lereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> PZAulh�orizedA aril <br /> Signature Receipt Date <br /> PASS CODE <br />�G OF1260 720 <br /> GENERATOR RETAIN <br />