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0 Waste"... No. 916004 <br /> systems TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> I <br /> GENERATOR <br /> Generator Name 1x171T•l? PTf)r)T1C!P!:; CnjZE1y-,11' Generating Location <br /> a Address 450 E. -C;Ftr7NTLM FCAD Address SAME <br /> SAME <br /> - 2 9 -``18 .13 5 9 3 3 <br /> Phone No. Phone No. <br /> BFI Waste Code C d Z Containers Type <br /> Description of Waste Quantity Units No. T e D- Drum <br /> ` C-Carton <br /> f B -Bag. <br /> T -Truck <br /> ❑ m ❑ P - Pounds F <br /> u Y -Yards <br /> J 1 - ❑ m ❑ O-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 261or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper con 'tion fo ransportation according to applicable regulations. <br /> BOB FAGUNDES,�UAM MUM= � <br /> F!: o <br /> 2- 16 <br /> 4 <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br />'Truck No. - '` Phone No. <br /> s <br /> Transporter Nam � � Driver Name(Print) <br /> t <br /> Address - isle License Na./State <br /> Vehicle Certification <br /> k <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> at ttt enerator site listed ve. out incident to the destination listed below. <br /> &IVe-r Si ure Shipment Date D e re Delivery Date_ <br /> f <br /> Site Name Phone No. �— { <br /> Address <br /> I hereby certify that the above named material has been accepted al o t e bet df owledge the foregoing is true and accurate. <br /> 4:5? } <br /> NarriF 'uthorized Agent Signature Receipt Date } <br /> PASS CODE <br /> 10186 BF1260-720 <br /> UNLOADING AREA QWY t <br /> _ _ J <br />