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Waste No - r <br /> Systems TM <br /> IRONG-FERRIS INDUSTRIESES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> venerator Name Generating Location <br /> kddress r 0 3c\ - ,1 - Address <br />'hone No J 1 r c a re v Phone No <br /> 11 � Containers Type <br /> 3Fl Waste Code 1 0 3 ) } 1 ! D - Drum <br /> Description of Waste Quantll Units No Type C- Cartor <br /> B - Bag <br /> \J\ HAZARDOLS T -Truck <br /> 501L ❑ m ❑ P - Pound <br /> Y -Yards <br /> ❑ O- Other <br /> E= <br /> 1:1 <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 /> CA <br /> or Authorized Agent Name Signature Cl Shipment Date <br /> _J TRANSPORTER <br /> Truck No `ice Phone No <br /> Daj lard Tiuckln -11t - Driver Name Print f ` <br /> Transporter Name (Print) <br /> Address <br /> 0 Box 21F Vehicle License No/State -4 I � <br /> Bvian California 94574 _ <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 wit` <br /> at the generator site listed above Ir---kms ISI out incident to the destination listed below <br />' aver Signature Shipment Date Dfiver Signature Delivery Date <br /> DESTINATION <br /> Site Name <br /> B F i 'Iva,,ro Roac Lr­)Of X11 Phone No <br /> -iOvl 'dot t17 \asr i; Res .:tN F r niore Co 94550 _ - -- <br /> Address ~~ <br /> I hereby certify that the above named material has been accepted and t Ae best of my knowledge the foregoingis true and accurate <br /> Warne of Authorized Agent Signature _ / / Recei t Date <br /> / PASS CODs= <br /> 10186 �� BF12C <br />