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��CER TRACTOR SERVICE <br /> Nm-HAZARDOUS MANIFEST. <br /> E GENERATOR NAME NUR CAL BEVERAGE GENERATING-LOCATION SANE <br /> ADDRESS j 080 E FAELIC10IT <br /> # CITY, STATE & ZIP PHONE.# _ <br /> CONTAINERS:. NO. VOL t WEIGHT <br /> TYPE: TANK TRUCK ~Y . DUMP TRUCK ; DRUMS OTHER <br /> WASTE DESCRIPTION:' SOIL �!` GENERATING'PROCESSTANK REMOVAL <br /> G� FDESCFqTION OF WASTE . , t,°> • „ . QUAY= ., ,•. +: TYPE_ t <br /> 2. <br /> PROPERTIES: PH SOLID LIQUID SLUDGE; SLURRY -OTHER I <br /> HANDLING INSTRUCTIONS: <br /> i THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100%NON-HAZARDOUS AS . } <br /> DEFINED SY,'40 CFR PART 261 OR ANY.APPLICABLE STATE LAW. AND'HAS BEEN PROPERLY <br /> DESCRIBED,�'CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRANSPORTA- <br /> TION ACCORDING TO APPLICJABLE REGULATIONS. <br /> 7-4L7 4 <br /> Typed ar Printed Full Name and Si ature Dates <br /> �. <br /> NAME PLACER TRACTOR SERVICE TRUCK # k: W <br /> `ADDRESS ,. P.O. BOX 170" DRIVER NAME '` YY1� <br /> a CITY, STATE & ZIP LOOMIS,CA, 95650 SERVICE ORDER it G I to - - <br /> d <br /> PHONEA IF <br /> k Typed or Printed Full Name and Signature? a-Dat G r <br /> DISPOSAL FACILITY HULSEY LANDFILL . _..... ._ PHONE #£�F :Y 915-383-2122•. <br /> z ADDRESS 8597 JACKSON ROAD � � � D POSAL METHOD <br /> CITY, STATE & ZIP SACRAMENTO,CA-�95826 y LANDFILL _ �: , :OTHER <br /> q ` a'Typed or Printed Full Name and Signature'.-:' Date <br /> DISCREPANCY: <br /> .Mry."k .y,.•wp a - r�- ...:J i._s w' .. •-.n.-v. - _ - .-- - -r�z"`'"f. <br /> t <br />