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Waste No: 916021 <br /> BROWNING-FERRIS Systems TM , NON-HAZARDOUS INDUSTRIES SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> AIL <br /> f)]ai'•7.'.� .��1lJ�t. .~�'.,., (_ : . <br /> Generator Name Generating Location <br /> Address 450 E. GRANT= Rr`JAD Address SAME <br /> 4 <br /> TRACY, CA . 95376 SAME <br /> Phone No. 8 3 5 9 1 3 _3 Phone- No. 5 9 1 3 3 . <br /> • ' <br /> BFI Waste Code I 4 1 O { R G[ Z 3 4 3 Q Containers Type <br /> Description of Waste Quantitv Units No. Type D- Drum <br /> { ❑ B - Carton <br /> So;1 v/ �; �Q� � � � � B - Bag <br /> i <br /> mT -Truck <br /> El P - Pounds ` <br /> Y -Yards <br /> 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 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper condi ' or tr.. portation according to applicable regulations. i <br /> HCS FP,G[JL�IDFS, PLANT N J 0- <br /> 4 -1 6 Z 6 12 1?. 1 <br /> Generator Authorized Agent Name Signature Shipment Date <br /> i <br /> Truck No. f/ Phone No. <br /> i - t <br /> Transporter Name I Driver Name (Print) <br /> 4 � <br /> Address Vehicle E . <br /> Vehicle Certification _2.0 9 7 f <br /> Z i <br /> hereby ce aYth named material was picked up . I hereby certify abov ne�axned material was delivered with- <br /> at the ge erator site listed abo e. out inti o the destination)sted below. ' <br /> i <br /> Driver Sig re Shipment Date Drive Delivery Date <br /> DESTINATION. <br /> Site Name Phone No. �— <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best.of my-knowledge.the foregoing is true and.accurate. ; <br />[ Nap,. Authorized Agent Si nature : eceipt Date ' <br /> L f <br /> PASS CODE <br /> 10186 BF1260.720 <br /> UNLOADING AREA COPY <br /> _. F <br />