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W St No. 916029 <br /> systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> BROWNING-FERRIS INDUSTRIES <br /> GENERATO <br /> ...._. <br /> Generator Name Generating Location <br /> 450 E. GRANTME Fes• SAMC <br /> AddressSAME <br /> Address i <br /> TRACY, CA 95376 i <br /> 8 3 5 9 3 3 2 0 9 --8 3 5 1 3 3 <br /> Phone No. Phone No. <br /> © Q S I d 3 d Containers7Drum <br /> BFI Waste Code Description of Waste quantity Units No. Type <br /> T -Truck <br /> m ❑ <br /> P - Pounds <br /> E:L= 7Y -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, i <br /> classified and packaged, and is in ZZ <br /> on for ansportation according to;applicable regulations. <br /> re Shipment Date <br /> Generator Authorized Agent Name <br /> • <br /> l T . Phone Nb' <br /> Truck No. <br /> r r <br /> Transporter Name U Driver Name (Print) <br /> v A? 4 <br /> i <br /> Ga <br /> Address .C_.x/ . Vehicle License No.lState 2Z-4 <br /> _ . <br /> k Vehicle Certification i <br /> hereby certi�t ;,ttheabav named material was picked up I hereby certify that the above named material was delivered with <br /> F at the generator site listed above. out incident to the destination listed below. <br /> Q <br /> Driver Signature Delivery Date ' <br /> Driver Signature Shipment Dale g <br /> Phone No. <br /> Site Name <br /> Address <br /> l:hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> -me of Authorized A ent <br /> SI nature � <br /> r• PASS CODE <br /> BFt260-, <br /> 10186 0. ' <br /> UNLOADING AREA COPY <br />