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Waste No 73027 <br /> Systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> ROWNING-FERRIS INDUSTRIES <br /> GENERATOR <br /> generator Name Generating Location <br />+ddress r 0 Esus ,415 Address 3128 h E' i, ian,ir Holt Di <br /> i'(itlbr0n i+' - i-i 0- id13 <br />'hone No 1 FFE3 I Phone No —� - <br /> 3FI Waste Code C a l 0 Containers Type <br /> Description of Waste Quantity Units No T pe D - Drum <br /> E ' _J C- Carton <br /> 1 B - Bag <br /> NO% HAZARDOL S T -Truck <br /> SOILF I I I ❑ m ❑ P - Pounds <br /> Y - Yards <br /> ❑ m El -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 /> 7-,AG 1)FMHEz?a 2 <br /> gene for Authonzed Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> ;1G-U3-1-680 <br /> truck No M2 Phone No <br /> Transporter Name Dillard Truu?ing Inc 2 55 Driver Name (Print) <br /> Address P 0 Bok 2�8 Vehicle License No/State —Z � ry � <br /> Btiron Cailfcrni3 94614 <br /> Vehicle Certification ZLY a' <br /> I 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 the destination listed below <br /> � y <br /> 1" F?_ / <br /> Dnveqstore Shipment Date Dr ore Oeiivery Date <br /> DESTINATION <br /> Site Name B T I %acro Read Landfill Phone No — 4 <br /> 4001 North \asco Rd Litermore Cd 94550 <br /> Address <br /> I hereby certify that the above named material has been accepted and #o h�e best knowledge the foregvtftg is true and accurate <br /> ,7 <br /> a f Authonzed Agent Signature Recei t Date <br /> PASS CODE <br /> 10!66 - <br /> 81=1260 <br /> 1 <br />