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NON - HAZARDOUS WASTE MANIFEST <br /> D 11559 <br /> PROFILE NO �1r <br /> 1 800 458 3038 <br /> ❑ BAKERSFIELD ❑ YOLO ❑ PHOENIX <br /> NOTE This form to be In lieu of the Toxic Substance Controls hazardous <br /> waste manifest To be used for NON-HAZARDOUS WASTES only <br /> Name MR. ROBERT FOWLER <br /> ri <br /> _7 Mailing Address 1211 S TURNPIKE ROAD <br /> City/ State 1 Zip STOCKTON, CA <br /> Phone No <br /> 209-463-4786 Contact MR. ROBERT FOWLER <br /> Signature Date O- C1 <br /> - / <br /> JTHE GENERATOR CERTIFIES THAT TH ASTE AS DESCRIBED IS 100% NON-HAZARDOUS <br /> a. <br /> Waste Description MBNITORING WELL SAMPLING <br /> 5 1211 S. TURNPIKE ROAD, STOCKTON, CA <br /> O Generating Location <br /> s3 (r -CrCr L E <br /> M Handling Instructions <br /> 0 Quantity I ]BBL CXIGLS C 1YDS C TONS <br /> 'J <br /> CONTAINER TYPE CXJTANKTRUCK C IDUMPTRUCK C DRUMS C ]BINS C ]OTHER <br /> DESIGNATED FACILITY <br /> NAME SEAPORT ENVIRONMENTAL SERVICES ADDRESS 675 SEAPORT BLVD. <br /> CITY/STATE/ZIP <br /> REDWOOD CITY, CA 94063 PHONE4 650-364-8154 <br /> �- MP VACUUM TRUCK SERVICE <br /> LU TICKET ! TRACTrTRLRfi -S.: 1 7 /--3- <br /> Z� a <br /> a: MP ENVIRONMENTAL SERVICES, INC Bin Nos <br /> Q Signature <br /> tL 3400 Manor Street <br /> Cn Bakersfield, CA 93308 Date --- <br /> Z 805/393-1151 P'U DATE 10-CSO Job# <br /> a <br /> ix <br /> Name SEAPORT ENVIRONMENTAL SERVICES Disposal Method <br /> Address <br /> 675 SEAPORT BLVD ❑Landfill Other <br /> � <br /> City/State/Zip <br /> REDWOOD CITY, CA 94063 <br /> 4 Phone No 650-364-8154 Time Pm <br /> Discrepancy <br /> t- <br /> Signature Date / <br /> GENERATOR 'RETAIN <br />