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t ,VNI'VERSAL ENVIRONMENTAL a <br /> P.O.BOX 996,BEIVICIA,CA'94510,(707)747-6699 •'' ` ff' 7} <br /> NON-HAZARDOW PECIAL WASTE MANIFEST <br /> 1 <br /> GENERATOR <br /> Generator Name -Tares is Trans oxGati'*n Generating Lo <br /> c'atian Sia 17, <br /> Address 904 1 victor. ltd. Address cri <br /> ' <br /> Lodi.i <br /> f . 1 <br /> r. P Phone No. ]^ <br /> I' Containers'' TYpe <br /> D' i tion of Waste ;Ouantit Units' No. T `$ b=Drum' ' <br /> C-Carton <br /> ,0 6 10 <br /> .! Yl a Bag' ' <br /> II ,i T 4 Truck <br /> '= ` arab':". it G'ith"Fuel. � .Lti3 <br /> P- Pounds <br /> ( .1 Y-Yards <br /> O.,Other f <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 pa ckAgsd, and is`n proper condition for transportation according to appli able regulations. <br /> l.. i <br /> +.Generator Authorized Agent Name Si nat <br /> Shipment Date v <br /> TRANSPORTER <br /> i Truck No. ..•.., Phone No. 70-747'.6649' <br /> Transporter Namenie�e8nviroaxittl Driver Name (Print) <br /> Address 1098 Park Road Vehicle License'iNo./State <br /> Vehicle Certification ' <br /> I hereby certify that the above named material was picked.up I hereby certify that the!above named material was delivered with <br /> at the;generator site listed above. out incident to the d stination listed below. <br /> ar S nature r Shipment Date Drtver Signature <br /> +r §u Delivery Date <br /> ji <br /> DESTINATION <br /> Forward LAt fill � <br /> Site Name. Phone No. ' <br />' Address' <br /> 5V- xter trT St Qektan .C�, 45206'.' r i <br /> certity that the above•named material has been acc�pk orthe bes ,of ' kno�edge foregoing i rue and accurate. ; <br /> Name of Authorized Si natuh _,, <br /> Receipt!Date <br /> �vr- <br />