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OV�laste <br /> S stems.TM No. 916 0:•4:2- <br /> BROWNING-FERRIS INDUSTRIES NON-> AZARDOUS <br /> SPEC TAL WASTE MANIFES <br /> GENERATOR <br /> Generator Name <br /> Generating Location <br /> Address <br /> Address <br /> f�flt]no,lo - !' - i s .+"., ti ..,� - '4g•,S J#k '•`Y ,� �i'•YT-. 'r � ,. •-.Y � a ., <br /> No. _ i <br /> BFI Waste Code U S ( Containers TYAd� <br /> Description of WasteD- Drum <br /> t O.uantity Units No. T e <br /> SOiI w� �t�'S@ 1 S m B -Cartor <br /> L C 1 4 ! B. Sag <br /> T -Truck <br /> i <br /> m11 <br /> P -Pound: <br /> Y-Yards <br /> 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 nota 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 cond' ' n for t sportation according to applicable regulations. <br /> BOB FAG[UMS,:PIAM rANA= (� Gl r o 2 <br /> Generator Authorized Agent Dame S[gnature shipment Date <br /> TRANSPORTER <br /> Truck No. U <br /> Phone No. <br /> Transporter Name � Driver Name (Print) <br /> Address /a Vehicie.License No./State 11-IC7 3 <br /> didle-Certification. <br /> I hereby certify that the above named material was�pi kd,up Jrget�aby certify that the above named materiaf was delivered witt- <br /> 7 <br /> et the generator.site fisted above.' t/ fbu`t'incident to the destination listed below. <br /> 0 9 <br /> 0. a77 q <br /> Driver Signature Shipment Date aver Signature Deliverg Date . <br /> DESTINATION, <br /> Site Name <br /> Phone No. —1 T <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 /> ,a of Authorized Agent Signature A ceip Dale <br /> PASS.CODE <br /> ]0186..• a <br /> .. •BFI260-72 <br /> ` <br /> UNLOADING'.:AREA Copy <br />