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.. .,Waste - . . . <br /> r No: 915934 M <br /> Systems TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name �11d.r; i:'T,5?1;T ' ' ; {Y 1n1�'�' � � • i <br /> Generating Location <br /> Address 450' E. GRANITMm Address :SAME <br /> 95376 :SAM i, <br /> Phone No. x8. :3, 5.� 9' 1 '. 3 Phone No.2 2 a' `8 3 3 3 <br /> 71 <br /> BFI Waste Code C Lz4 O ?— �( Z 3 9 3 3 D Containers Type <br /> Description of Waste D- Drurn <br /> p Ouantit Units No. Toe <br /> {{ r C- Carton <br /> So. I w �t�Se 1 FYI b M I ' 1 B - Bag j <br /> T -Truck <br /> i <br /> m ❑ P - Founds <br /> Y-Yards <br /> - t <br /> E m ❑ 0-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 f#w, has been properly described, <br /> classified and packaged, and is in proper condition for tr, sportation according to applicable regulations. <br /> BOB FAGUNDFS, PIANS W, C e u1_)jL j b. 6 of17 <br /> ,Generator Authorized Agent Name Signature Shipment Date <br /> AfTRANSPORTER,,— <br /> Truck No. Phone No. <br /> Transporter Name -/(f. <br /> l l <br /> P Driver Name (Print) <br /> Address C4 Vehicle License No./State <br /> Vehicle Certification <br /> 1 hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> at th neratar i listed above. out incid t to the destination listed below. <br /> 4 9 2 / 2 G '� <br /> river Signature Shipment Dale Ori Signature Delivery Date <br /> DESTINATION- <br /> Site <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 /> N if Authorized Agent Signature _ Receipt Date <br /> PASS CODE a <br /> 70186. • • 1-* SF.1260-720 <br /> UNLOADING AREA COPY <br />