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waste AS <br /> .. No. . .916024 <br /> Systems TM <br /> BROWNING-FERRIS INDUSTRIES =: NON-HAZARDOUS SPECIAL WASTE MANIFEST i <br /> GENERATOR <br /> Generator Name 101 V?f; PM'rxx7IS C `tri:!r_' Generating Location SIVI' 1 <br /> Address ._ _ 450 F_ ,RAtn'1,T�FDAD Address SAME <br /> is <br /> TRACY,'C A_ _.25376 SAME <br /> Phone No. Phone No. 2 0 9 $ 1 3 1 5 1 9 1 1 1 3 . 3 <br /> r� <br /> Containers TypeBFI Waste Code <br /> D- Drum <br /> (( Description of Waste Quantity Units No. Type <br /> El ` 11 C - Carton <br /> B Bag � <br /> ❑ m T -Truck <br /> P - Pounds <br /> Y -Yards � <br /> t <br /> ❑ m ❑ O Other i <br /> 1 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 ' for tral7portation according to applicable regulations. ' <br /> n C <br /> PPOB FAGUNIDES i PTA V MAMA= L4• A)4 ! d 2- 1 6 moi' <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER' <br /> Truck No. f Phone No. - 1 <br /> Transporter Nam v ,o Driver Name (Print) R� <br /> Address Vehicle License No./State ; <br /> i <br /> Vehicle Certification <br /> I hereby certify that the above named material was picked-up 1 hereby certify that the above named material was delivered with- <br /> at the generators i a">isted above. out incident.to-the destination listed below. <br /> 15 i Z <br /> Driver'Si 11V Shipment Dateer Sig Delivery Date <br /> / DESTINATION <br /> Site Name Phone No. ^� w <br /> Address <br /> } <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 /> 2 <br /> Nar" Authorized Agent <br /> Signature Receipt Dale 1 <br /> • • PASS CODE <br /> 10!86 <br /> 13F1260-720 <br /> .UNLOADING AREA COiPY,.. : . : .....': <br /> ..J <br />