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Om <br /> Waste No t ;� 0 2 <br /> SystemsTRIESTM <br /> NTNG-FERRIS fNDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> BR <br /> GENERATOR - <br /> Generator <br /> Generator Name Generating Location <br /> Address r 0 Ito\ 44 Address " 23 t� rpt", , n !n t r ' t D' <br /> ho. t:Loll Te,-: 7 ,!C <br /> Phone No Phone No <br /> C a # 0 } l t Containers Type <br /> BFI Waste Code m D- Drum <br /> Description of Waste Quandty Units No Type <br /> C - Cartor <br /> f B - Bag <br /> NON HAZARDOLS T -Truck <br /> S03 L ❑ m ❑ P - Pound <br /> Y - Yards <br /> F] m 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 /> G ator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> ,I0-634-3850 <br /> Truck No h Phone No <br /> DLIlard Truct:inu Inc 2 7 } � GMLAk12,Y- <br /> Transporter Name Driver Name (Print) <br /> Address <br /> 0 Bo% 2118 Vehicle License No/StateCp�'f°rnt <br /> £t,,ron Califoinja 94514 -Z(-,) 5�+� 4iq9Z <br /> Vehicle CertificationI hereby certify that the above named material was picked up I hereby certify that the above named material was delivered wit, <br /> at the generator site listed above out incident to the destination listed below <br />":,:i��,f�s� 1 U H . Z '� <br /> Driver Signature Shipment Date Driver Signature Delivery Date­ <br /> DESTINATION <br /> Site Name ? F I Vasco Roan Laildf 31 Phone No L=— 4 F,TO Lj 9 <br /> L,301 \orth �asro Rd L, e Ca 9�55C <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my knogfed- e-t re6oing is true and accurat, <br /> s <br /> e of Authorized Agent Signature t na e <br /> Com/ <br /> PASS GODE <br /> 10/86 BFI26 <br />