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Waste N� 951959 <br />;a, Systems TM <br /> iOwNlNG-f EAR15 INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> t',=�. �.�rlce_ = Zit .�CC�� 5'_sLs.. • •-'3 <br /> enerator Name Generating Location <br /> ddress P. 0. Box 5155 Address 3788 Tracv Blvd. <br /> 5a i Ramo-, Ca. 9-583 Trac-, , Ca. <br /> hone No [=—I 2 7 7% ' 3 :61::8 Phone No �— <br /> FI Waste Code C a E � 0 ' 0 1 9 . 3 5 3 1 Containers Type <br /> Description of Waste Duanti Units No Tvne D- Drum <br /> C-Carton <br /> FFF i E] Ei <br /> B - Bag <br /> Non hazardous Soil ❑ ❑ T - Pu <br /> ck <br /> P -Pounds ds <br /> Y -Yards <br /> El 1 1 171 D <br /> m ❑ O-Other <br /> I 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 Part 261 or any applicable state law, has been properly descnbed, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> n r ' J � t� <br /> 1 tJI�OC L. <br /> ............ <br /> merator Aulhonzed Agent Name Signature Shipment bate <br /> TRANSPORTER <br /> 510-634-6850 <br /> ruck No 49 Phone No �1/ <br /> ransporter Name Dillard Trucking, Inc. 1431/93 Driver Name (PnnQ Kf <br /> ddress P. 4. Box 218 Vehicle Ucense NoJState <br /> Byon, California 94544 3e a 1?'/ L <br /> Vehicle Certification <br /> hereby certify that the above named matenal was picked up I hereby certify that the above named matenal was delivered with- <br /> t the generator site listed above. out incident to the destination listed below <br /> fiver Signature Shipment Date 3iw r Signature Deitvwy Date <br /> DESTINATION <br />,ite Name B.F.I. Vasco Road Landfill Phone NO 5 1 1 0]_F4 [4 7 j 0 1 4 1 9 1 <br /> 4001 North Vasco Rd., Livermore, Ca. 4550 <br /> address <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> 121111111P Authorised Agent i $ Receipt 044- <br /> PAW <br /> tPASS CODE <br /> 0M BFM60-720 <br /> TRAIvSPORTER RETAIN <br />