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� • I <br /> I' <br /> Waste No <br /> Systems TM <br /> BROWNING-FERRIS NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> INDUSTRIES <br /> GENERATOR <br /> Generator Name Generating Location <br /> T't` 3i 28 h Bell 1n, i 'i[I , t JTAddress Address <br /> r <br /> Phone No = 1, 11 1 1 J Phone No <br /> BFI Waste Code a { C ' t Containers Type j <br /> Desch dT pe tion of Waste Quant Units No D - Drum <br /> G G' -Carta <br /> B <br /> � 1 B - Bag <br /> SOILI NAZARi10t S El El 7 -Truck <br /> SO Y L P - POUnC <br /> Y - Yards <br /> ❑ J� F] O-Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260W10 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 /> g9norator <br /> CAuthorized Agent Name Signatur4V Shipment Date <br /> I <br /> TRANSPORTER <br /> 310-631-680 <br /> Truck No /L Phone No <br /> .rlllard TruCKIs-� 1, r 2 55 G/�CC01Y A <br /> Transporter Name Driver Name (Print) <br /> Address n 0 $°y 2:8`' Vehicle License No/State �A��-2 Sy - - - <br /> Bxrnts Caiifurrsia 911:�1-i <br /> Vehicle Certification 7--1y3"c�- <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered witi <br /> at the generator site listed above out incident to the destination listed below <br /> " 9 a aoffi <br /> Driver Si nat r Shipment Date Dnver Sidnat&b Delivery Date <br /> DESTINATION <br /> B >" i <br /> Site Name Phone No 1a5C� �c Ci L'nCfall 1 v r g <br /> - <br /> 4,01 iu L„ 19s c L )% eiTure La 91-550 <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of g)y_kn TFt�oregoing is true and accuratE <br /> NNW of Authorized Agent Si nature -- Reoei f Date <br /> PASS CODE <br /> 10186 <br /> BFI26i <br />