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NON - HAZARDOUS WASTE MANIFEST <br /> 0 11173 <br /> PROFILE NO --- <br /> �} <br /> �LD 303n — <br /> � Y01_0 °F-CENIX <br /> NOTE This form to be In lieu of the Tox c Substance Controls hazardous <br /> waste manifest To be used for NON-HAZARDOUS WASTES only <br /> ��"'v/./ny M1r��I�r��Ivy 1tiI��� nV��� A..V /r /.�.wy����.�•ti�M1I ti/1n..���� ► ��.y rV��� /����Iy by.ti N����n'�rr.y y n— <br /> Name MR ROBERT FOWLER <br /> � Mailing Address <br /> 1211 S TURNPIKE RO-D <br /> Ld City, Slate / Zip STOCKTON, CA <br /> LU 209-463-4786 Contact MR. ROBERT FOWLER <br /> O Phone No <br /> m Signature Date <br /> LU I THE GENERATOR CERTIFIES THAT THE 1 LSTEAS DESCRIBED IS 1000o NON-HAZARDOUS <br /> t-- <br /> LIJ <br /> rl. <br /> Waste Description MONITORING WELL SAMPLING <br /> O ! Generating Location <br /> 1211 S. TURNPIKE ROAD, STOCKTON, CA <br /> U , <br /> LU <br /> ' Handling Instructions <br /> Quantity <br /> _BBL LX-GLS _ _ YDS _ _TONS <br /> CONTAINER TYPE. C X''IANK TRUCK r ___t 9�TPUCK L 1 D:z U 1,1 S L -ZEINS <br /> DESIGNATED FACILITY <br /> I NA1,4E SEAPORT ENVIRONMENTAL SERVICES ADDRESS 675 SEAPORT BLVD <br /> CITY STATE/ZIP REDWOOD CITY, CA 94063 PHONE = 650-364-8154 <br /> TRACT TRLR; __A <br /> MP VACUUM TRUCK SERVICE <br /> rr MP ENVIRONMENTAL SERVICES, INC = = <br /> d I 3400 Manor Street A <br /> Bakersfield CA 93348Z I 805 , 393 1151 _ SJoa= <br /> E— <br /> Name SEAPORT ENVIRONMENTAL SERVICES Disposal Method <br /> I675 SEAPORT BLVD. ❑Landfill Other <br /> Address <br /> > ' <br /> h <br /> CltyrStale/Zip REDWOOD CITY CA 94063 <br /> U <br /> 650-364-85ime am <br /> tai 14 T <br /> � Phone No <br /> o Discrepancy <br /> I � <br /> Signature _ Date <br /> GENERATOR RETAIN <br />