Laserfiche WebLink
t- <br /> E`'. <br /> W. <br /> LIE 115NIVERSALENVIR©NMENTAL {F§ � <br /> = �No.. <br /> P.O.BOX`996 BENICIA,CA 94510,(707)747-6699 <br /> '� 0 I <br /> N0N-HAZA RDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name Ts i;,i ratt�p�.�rtatior, "` Generating Location:' <br /> ` Salk <br /> Addei%s SOD 1 VtOr "0 .Address <br /> 'Lor ij. CA M.46 <br /> Phone No 1 — . �a �► i Phone No. k <br /> _117! - <br /> w Containers Type; <br /> Description of Waste 14 Ouahtity Units No. Type D-Drum r <br /> ❑ C-Carton <br /> 4 r"t � .B- Bag <br /> $�rsat: aat cz 'Sfr . =7 s ks � T -Truck <br /> io <br /> r m 0., P - Pounds u <br /> Y-Yards <br /> - O. Other <br /> f I hereby certify that the above named material does not contain free liquid as;,defined by 4b 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 proper condition for transportation according to applicable regulations. <br /> Generator Authorized Agent Name Signature 4 Shipment Data <br /> ,- TRANSPORTER " <br /> Truck No -_ _� �. Phone No. 707 7-66 � <br /> e.�e�i.� �zt��t:o�sta�t�s�:L ,r <br /> Transporter Name Driver Name (Print) ' . <br /> Address 3. 5Park ` Vehicle LicenselNo.IState u: f'T <br /> t.? .0 CAiS im, 4ehi611e Certification _ <br /> l ..' I hereby certify that the above named material was picked up I hereby certify that the aboye�named.material was delivered with <br /> at the generator site listed above:"` ciut incident to the destination listed below.' <br /> { ,�. •� ter'' , > � '` IISr <br /> r <br /> -,r e" r^" ✓ ..r` ww��zn+n.. ..__..._Eo, <br /> P11! `' E'-,.,�r o.r .r� 'a'� sr�r�.:y. sm•r' f" r W7 F <br /> Driver Signature Shipment Date' river SFgnalure 4� Delivery Date' <br /> GEST#NATION <br /> + r€ a L l8 i r r <br /> Site Name r <br /> Phone No - {� a4 �� � <br /> i � s <br /> �,1 a Wf Charter tf ay 8 St,0c t ofto.. CA 95"' <br /> Address `v <br /> I • 'sby certify that the above named material has been,accepted,�and Io the best/of my_knowledge the:foregoing is.true and accurate. <br /> 4! <br /> s <br /> Name of Authorized Agent __- "Signature .-_ t ( Receipt Date <br />