Laserfiche WebLink
� f l ✓ <br /> LF= UNIVERSAL.IENVIRONMENTAL w� t — .. i •�b <br /> , .•, 1 U 6 2 <br /> P.O.BOX 90,BENICIA,CA 94510.1767}747-6699 a ! <br /> NON-HAZARDQUS. SPEC' AL WASTE MANIFEST <br /> ' GENERATOR <br /> Generator flame J - )�G _ Generating Locationrl <br /> /[",�"yam) <br /> Address <br /> _:-Address -"--"' <br /> r Phone No. � J I I ne No. T <br /> �, 9 Co#ttainers Type <br /> Description of Waste J Quantity Units No., Type D- Drum <br /> Cy C-Carton t <br /> Bag..0 - <br /> �J ?. [_ ; .l �.:?.r::.,f J j`. 6 ;I. ' -Truck <br /> �... E m P Pounds <br /> J 1',�;-/. .•�'~� �+ Y Wards <br /> R. f E m [1. O-Other <br /> I hereby certify that the above named material does not coritain free liquid as;,defined by 40 CFR Part 260.10 or any applicable <br /> state law, is not a .hazardous waste:es defined b 40 CF Part 261 or any applica6le.state law, hasibeen properly:described, <br /> x..', classl itJti acid pad ged, arrd is inr�rtSporfation ad'c`�, 'Pt -applicabre-regulation' ; <br /> Generator Authorized,Agent Name Signature Shipment Date <br /> ` TRANSPORTER <br /> 1 . <br /> sr <br /> � <br /> �:.•r ' <br />�. Truck No. .Phone No. <br /> t Transporter Name V <br /> `�}� I ' �� � �"���• Driver Name (Print): <br /> / i tate �> <br /> Address ` `* Vehicle License-No.1.S - <br /> i <br /> l �,;,' .� ✓J' �1 ... -f 4 -- ---- ------`'Vehicle Certification <br /> 1 hereby certify that the above rt ,med material was picked up I hereby certify that the above named material was delivered with- <br /> at the generator site listed abotiA. out incident to <br /> qq the destination listed below. <br /> D6ei Signature Shipment Datel Driver`Slgnattlre � {✓ Delivery Date <br /> i <br /> DESTINATION <br /> 7 <br /> Site Name Phone No,!�T <br /> . Addressy. li�,�. <br /> I�)by certify that the above named material has been accepted apt to the best of my knowledge the foregoing is true and accurate. i <br /> Name of Authrxized Avant Signature ;R. Receipt Date <br />