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y <br /> LIEUNIVEPSAL ENVIRONMENTAL M <br /> P.O.BOX 996', BENICIA,CA 94510,(707)747-6699 <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name f Generating Location <br /> Address ` ��rX Address <br /> Phone No. —1` i. =_ <br /> ` Phone No°`�� <br /> Containers Type <br /> Description of Waste _QuantityUnits No. T pe Q- Drum <br /> r a C-Carton <br /> fT Truck <br /> P - Pounds <br /> Y - Yards <br /> F m F] p Other <br /> `. <br /> 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 Pa't 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 /> ;r <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. ' l '� w' Phone No. <br /> Transporter Name/,)'/'/'.' �l �t � � �_,�r.�a:..,.��: � .., Driver Name (Print) /,.l,.l�' ) <br /> AddressVehicle License No./State} 3; ' <br /> -. �'-' 1. ^+ter ✓�, ' :.A g 'a''S� a 9La�.. <br /> ' Vehicle Certification e <br /> I hereby certify that the above named material was picked up l hereby certify that the aboV6'named material was delivered with <br /> at the generator site listed above. out incident to the destination listed below. r " <br /> ' '`e Cryo ,.J' / f��v �'' ,1` '��„`"''� w�•f >w” t �... �,� f' �. <br /> Driver Signature Shipment Date _ Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name `'' _ , �e�i=s"_ ;, : Apr'"r. Phone No. �— <br /> Address r .;""" <br /> I w—eby certify that the above named material has been accepted and to the best opmy knowledge the foregoing-is'true and accurate. <br /> 611 2L <br /> Name of Authorized Agent Si nature Receipt Date <br />