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I <br /> Waste No 7 i 2 <br /> Systems TM <br /> ROG-I^E,RRI5INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> •R <br /> ienerator Name Generating Location <br /> t n R int <br /> ddress Address <br /> l <br />'hone No Phone No <br /> AFI Waste Code C 0 a 0 4 12 ) -' 9 k 1 ! Containers Type <br /> Description of Waste Quantity Units No T pe D - Drum <br /> U 0 g F9O - Carton <br /> 0 <br /> L E B - Bag <br /> %ON r;AZARDOCS T -Truck <br /> SOIL I I J-] I I ❑ m F] P - Pound: <br /> Y -Yards <br /> ❑ m ❑ O-Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 1100 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 RFG �FMAFL7U Q Z <br /> ae Authorized Agent Name Sgnature Shipment Date <br /> TRANSPORTER ' <br />(ruck No Phone No <br /> Di 1 laz d i ruckine Ing, 2 �� f , <br /> transporter Name Driver Name (Print) <br /> 4ddress P 0 BOS 2'111 Vehicle License No/State <br /> Bron Califorf,iP <br /> Vehicle Certification <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with <br /> at the generator site listed above out Incident to th destination listed below <br /> Driver Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATIOW <br /> Site Name <br /> 8 F I Vasco Rr;,-- Phone No <br /> a Landfill ' v — 4 I O <br /> 4001 \ort! \as a <br /> Address <br /> hereby certify that the above named material has been accepted and to the best of my-knowledge the foregoing is true and accurate <br /> me of Authvnzed Agent SI nature / Recel t Date <br /> i <br /> i PASS CODE <br /> �/ BF1260 <br />