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i <br /> V Waste N 0 <br /> S]/Sel'YiS 7M _ <br /> RQWNING-FERRIS INDUSTRIES NON HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br />,enerator Name Generating Location <br /> address 0 Boa 4415 Address X128 h beii janilt1 rio11. Dr <br /> Huu�-tQn TF:tas 77,10-4415 <br />'hone No i —12 "i 8 c G Phone No <br /> IFI Waste Code 0 4 0 5 1 1 Containers Type <br /> Descrl tion of Waste Ouantit Units No ,Ty D-Drum <br /> u <br /> on <br /> 0 0 J 1 Fs B - Ba8 -Bagg <br /> NOINBAZARDOt S F-1m 1:1T -Truck <br /> SOIL <br /> P - Pounds <br /> Y-Yards <br /> EI01m ❑ O 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 q <br /> GROG J)CMAQ7(a � Z / <br /> senerator Authorized Agent Name Signatur Shipment Date <br /> TRANSPORTER <br /> Truck No Phone No <br /> D_11ard Tiuck-ina la( a� <br /> f'ransporter Name Driver Name (Pant) <br /> kddress r Bd1 218 Vehicle License No/State <br /> Lv; oi, California 04i1- cr <br /> Vehicle Certification —4::� <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> it the generator site listed above out incident to the destination listed below <br />]river Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name u P - \asco Road : L><,'f, 7 ! Phone No , 0 — - s ; a 'i <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> Ili <br /> a uthonzedAgent Signature j ( Recei t Date <br /> PASS CODE <br /> 10186 <br /> BF1260 7- <br />