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LLWaste No ; -1 <br /> s]/StG'CYIS TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • <br /> Generator Name �`�' �i Generating Location i <br /> Address P 0 Bo% 4415 Address 312e t, Ber ari3n Holt r'3 <br /> t.lt�StQ33 Texas -7310-4415 Stc ktoj; _ +n• ,,,; <br /> Phone No 0 0 - ' , 7 Phone No <br /> BFI Waste Code 0 a14 0 5 ] FTT Containers Type <br /> Descrt tion of Waste Quantit Units No T pe D -Drum <br /> _ C-Cartor <br /> 1 B - Bag <br /> SOII:A2ARDOLS ❑ m ❑ T -Truck <br /> SOIL P - Pound <br /> Y -Yards <br /> El 1:1m 1-1O-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 described, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> Generator Authorized Agent Name Signatur Shipment Date <br /> - TRANSPORTER <br /> Truck No 0 Phone No 330-634-Gz)50 <br /> Dillard Trur'k3nL_ Inr 2 55 <br /> Transporter Name Driver Name (Print) <br /> Address P 0 Boli 21 S Vehicle License No!State % '7 ' <br /> 6\ron California 94514 2 �� 4 <br /> Vehicle Certification <br /> I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered wiff <br /> at the generator site listed above out incident to the destination listed below <br /> Driver �� Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name B £ 7 Vasro Road Landfill Phone No —14 4 17 0 4 <br /> 4001 North \asr o Rd LY%ea more Ca 91550 <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of wledg �for is true and accurate <br /> Authonzad A ent Si nature Recel t Date <br /> L---- �JPASS <br /> CODE <br /> 10186/ SFI26o <br />