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0 Waste No i <br /> Systems TM <br /> BROWNING-FERRIS INDUSTRIES WASTE MAN NON-HAZARDOUS SPECIAL W T <br /> BS MANIFEST <br /> GENERATOR <br /> Generator Name Generating Location <br /> Address Liu\ 4y13 Address 0128 t' <br /> rli3 V--1d1T f3i <br /> Phone No n 14— Phone No <br /> BFI Waste Code Y C Containers Type <br /> Description of Waste Quantity Units No T pe D - Drum <br /> C- Carlo <br /> B - sag <br /> \01', FIAZARDO, S T -Truck <br /> SOIL <br /> ❑ m ❑ P - Pounc <br /> Y -Yards <br /> 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 /> GPrrG 4FMn �c, JL_' , / ,may <br /> 3enarator Authorized Agent Name Signature � - Shipment Date <br /> xi <br /> truck No i Phone No <br /> D.il lard Ti rick-Ing Inc 2 5C <br /> Transporter Name Driver Name (Print) E ' r <br /> Address r 0 >;o ?1 Vehicle License No/State <br /> Br,ron Cal iforr is 9,51Y _ <br /> Vehicle Certification �7( <br /> t <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered Witt <br /> 3Lt 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 BF i %asco Road Landfill z -3 4 7 0 t �3 <br /> Phone No [= <br /> 4001 \or rh N, �:. a Ru L1% ermoi e C4 550 <br /> 4ddress <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 /> La Authorized Agent Signature Rac Dare <br /> PASS CODE <br /> 10/86 BF1260 <br />