Laserfiche WebLink
'LNiivERSAL ENVIRONMENTAL <br /> '4 <br /> P.0180X 99�,BENJCIA, CA 94510, (707)747-6699 <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator NameGenerating Locati n <br /> Q <br /> Address Y M = Address <br /> Phone No. Phone No, <br /> Containers Type <br /> Description of Waste Quantit Units No. T pe D- Drum <br /> c C-Carton <br /> r�) J <br /> -B- Bag <br /> T -Truck <br /> P - Pounds <br /> o Y-Yards <br /> F1F] 0-Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 26010 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 19 in proper condition for transportation according to applicable regulations. <br /> Ge I nerator Authorized Agent Name Signature Shipmefrit Date <br /> lk/ <br /> dle TRANSPORTER <br /> Truck No. <br /> Phone No. <br /> z <br /> Transporter Driver Name <br /> ansporter Name4, (PrintF <br /> Address <br /> Vehicle License NodState <br /> E. Vehicle,Certification <br /> 1v <br /> I hereby certify that the above named material was picked up <br /> I hereby certify that the above named material was delivered with- <br /> at the generator site listed4out t incident to the destination listed below, <br /> Driver Signature Shipment oat4 D hvbrSi6natura Delivery Date <br /> DESTINATION <br /> Site Name <br /> Phone NQ. ILT <br /> Address z- <br /> '-eby certify that the above named material has been accepted and to"'the b4st of rri`y'knowl`ed'ge the foregoing is true and accurate. <br /> 71� <br /> Name of Authorized Agent -Signature <br /> Receipt Date <br />