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6 <br /> Waste No <br /> Systems TM <br /> BR !NG-FERRIS IND RIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> IlST <br /> GENERATOR <br /> Generator Name Generating Location <br /> P 0 So, }-i 1` ? � � S� Tit 11 i '_,1 11 ho, <br /> Address Address c <br /> f"IL,-1011 'P\d- "7310 4it ' o r v 1 <br /> Phone No + Phone No EEL:E:= <br /> Containers Type <br /> BFI Waste Code W D - Drum <br /> Description of Waste QuantityUnits No T pe <br /> C- Cart <br /> Cor <br /> J a . Sag <br /> NON HAZ.aRDOL"S �.J El7 -Truck <br /> ElP - Pound <br /> Y - Yards <br /> T-1 F] 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 /> G for Authorized Agent Name Signatur Shipment Date <br /> X10-G3# -fS�O <br /> Truck No Phone No <br /> Dillard it ucl- in Inc 255 !/ <br /> Transporter Name Driver Name (Print) <br /> v <br /> Address P 0 BUN 218 Vehicle License No/States if <br /> Baron Califoinia 94-514 <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 out incident to the destination listed below <br /> - <br /> Driver Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> B r ? %asco Roaa Landrill 3 0 -t 4 ' 0 `t <br /> Site Name Phone No <br /> 4001 'tort kescu Rd Lig*ertroi r _ 915 C <br /> Address <br /> I hereby certify that the above named material has been accepted and to the`best o mf y knowledge the fore9;thg is true and accuratr <br /> L - <br /> ONa a of Authonzed Agent S+ nature / Recei t Dafe <br /> f <br /> PASS CODE <br /> 10186 BFi2C <br />