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Date: 11/09/2017 <br /> No_ rth�stair Non-Hazardous Waste Client# 10207984 <br /> Environmental , Manifest Document# 93304 <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 11. Description No.Containers Type of Container Qty. Units <br /> OWS Solids 1 T 1440 Gallons <br /> Section II. Description No.Containers Type of Container Qty. Units <br /> Water 1 T 675 Gallons <br /> Section II. Description No.Containers Type of Container Qty. Units <br /> Section III. Special Handling Instructions <br /> Section IV. Generator Certification <br /> I 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 /> 9 l� <br /> Kevin mctee <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 /> Receipt of Material(Driver's Signature): <br /> DESTINATION <br /> Section VI. Disposal Site: !!N(AM©V11 Profile4 1,35423300 <br /> _ <br /> Address U_a `�'_V Ah-Amoiit~ <br /> City,State,Zip CA 91+550 <br /> Signature Printed Name Date <br /> Section VIISpecial Notes <br /> Water treatment 2295 gallons <br />