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aNIVE4 NVIRONMENTAL266 <br /> , o <br /> P.O.-BOX 996 BENICIA. CA 94510,(707)747-6699 <br /> NON-H, AZINMOUS SPECiAL.WASTE MANIFEST <br /> GENERATOR fi" <br /> Generator�Name r Transpo:' atb)n _ Sam,Generating Locatibn <br /> Address 0 � � }t`[s ' dP <br /> Address. -t <br /> c � C. 9;524 7 <br /> � <br /> i <br /> Phone No' - <br /> Phone No. <br /> . .r <br /> Containers Type <br /> ,Description of Waste +' Quahti units Na. T Pe D- Drum <br /> Y <br /> rt C-Carton <br /> q 4 d ;,� .: ^� B -Bag . <br /> Lt� 'F f e fs'rx with V1161 & a? T. <br /> ,• Truck" <br /> <. Pf Ponds <br /> r r. 4 l ,Y-Yards <br /> ti <br /> ✓i W ❑ O Other' <br /> I hereby.certify.4hat the above named material does not contain free"liquid as defined,iby 40 CFR Part,266. any applicable <br /> state law,:-.is not a Hazardogi"waste"as `d6fined,by'40 CFR Part 261.or any applicable state.law, has b4e' nfproperly d„escritied, t <br /> classified.and pack�arged and is in proper condition for transportation accor_ding}to applicable regulations. <br /> Generator A <br /> ulhonzed d <br /> ii <br /> ent Name <br /> Agent Signature ;EEZTJ� <br /> Shipment Qate i <br /> TRANSPORTER <br /> Truck No.. <br /> Phone <br /> e No. i r <br /> Transporter Name �elrta . rtr ctrett r t Ii T” ;' �� ''"' '`�"' .'•': J <br /> Driver Name (Print) n.. - <br /> Address 18 Perk •f oad <br /> Vehicie License No./State` �✓ M-� 107..1,111"T" _ <br /> Benicia, 94.51 <br /> r <br /> Vehicle Certification ` ' v" f <br /> I hereby certify that the v <br /> aboe named material w <br /> _., ,� as picked u I hereb keit th <br /> P at tti�` <br /> y fy„ a above named material was delivered with- <br /> /at Fiat the generator site listed above.t'' out incident to`the destination listed below. <br /> s' , <br /> F <br /> .. V l f ✓''.r'r fY fir ��� ''- �;;jh v' jY :,. ..w �� <br /> 1 Diivef Signature fir•%'" Shipment Date - Drrver S=gnature <br /> Delivery Date <br /> DESTINATIONPorvaid Landfill <br /> l <br /> Site Name <br /> + '*� <br /> Phone No. ;" <br /> Address 1145 ,, Charter Way '�Stfa�: at�t�„ 'CA �fi �? <br /> F 'eby certify that the above named material has been accepted and to the bes(of my <br /> Ei l S ratire. � knowledge� fthe-f6reggingrris true&dcc'. <br /> urate�.r. <br /> horizedent { <br /> Name of Aut <br /> Receipt Date <br /> i' ,. <br />