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Waste� No <br /> Systems TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Generator Name Generating Location <br /> Address t' 0 Box 441: Address 3121 ti rie 1: "°"it, is It IJ <br /> Fouston Te\ds 7731,--44115 Stun ki _ "ni ifni: i�] 1 <br /> Phone No 2 Phone No <br /> BFI Waste Code t 0 Containers Type <br /> Description of Waste Quantity Units No Type D- Drum <br /> ,� f� C -Carton <br /> � _ ❑1 I �, ,V { ILl_JI <br /> �J B - Bag <br /> SOI fIAZ 4RDOt S Elm 1-1T -Truck <br /> SOIL P - Pounc <br /> Y - YardE <br /> ❑ m ❑ O-Other <br /> I hereby Y certif 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 /> 6-RF6 .D M�R� U �-� �b 2 15-17 JZ� <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Truck No Phone No <br /> 1 <br /> Dillard Trurkzrz Inc 2 55 ' r' <br /> Transporter Name Driver Name (Print), <br /> Address F 0 Bow 218 <br /> Vehicle License No/State <br /> Byron California 91514 <br /> Vehicle Certification A �� �%-- <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 /> 4 <br /> Driver Signature / Shipment Date Dnver signature Delivery Date^ <br /> r <br /> DESTINATION <br /> Site Name B F I vasro Ruad Landfill Phone No �— 4 7 1:0=11 <br /> 4001 'North lasro Rd L,-termoje Ca 94550 <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my kknn9wt6dge the foriri gg�g is,tru and accurate <br /> of Authorized Agent Signature Recei t Dat <br /> PASS CODE <br /> 10186 BFI2C <br />