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Yofthstair Date: 06/06/2018 <br /> Non-Hazardous Waste Client# 100207207984 <br /> _.Environmental Group Inc. Manifest Document# 95150 <br /> WASTE ORIGIN <br /> Section I. <br /> Origin Location: FEDEX GROUND <br /> Address: 5655 HOOD WAY Phone: <br /> City: TRACY State: CA Zip: 95377 <br /> Section II. Description No.Containers Type of Container Qty. Units <br /> OWS Solids 1 T 3085 Gallons <br /> Section II. Description No.Containers Type of Container Qty. Units <br /> Section I1. Description No.Containers Type of Container Qty. Units <br /> Section III. Special Handling Instructions <br /> Section IV. Generator Certification <br /> t hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260,10(soils)or any applicable state <br /> law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law,has been properly described,classified and <br /> packaged,and is in proper condition for transportation according to applicable regulations. <br /> Jose Jimenez <br /> Customer Name Customer Signature <br /> OWNER / TRANSPORTER <br /> Section V. <br /> Name of Co.: Northstar Environmental Group,Inc Phone: (800)449-7504 <br /> Address: 417 N.Blythe Street-Gallatin TN 37066 <br /> Driver: KEVIN JENKINS <br /> 4mL <br /> Receipt of Material(Driver's Signature): <br /> DESTINATION <br /> Section VI. Disposal Site: Profile 9 <br /> Address <br /> City,State,Zip <br /> Signature Printed Name Date <br /> Section VIISpecial Notes <br />