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aWaste ,{ <br /> No <br /> 5436 ? <br /> OSOteffs� -'­ <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Generato amen73 <br /> Generating Location �� Q <br /> A ` � <br /> Address <br /> X-N +� <br /> Address <br />_k � \ <br />'i Phone No. 'I,LLJ� Phone No. <br /> A �, <br />,, 8171 Waste Code <br /> Containers Type <br /> scription of Waste n <br /> QuantitV Units No T pe D_Drum <br /> � <br /> C Carton <br /> Ij \ 8-Bag t <br /> T -Truck <br /> EEI= ❑ ❑ P -Pounds <br /> Y-Yards <br /> O-Other <br /> m El <br /> I hereby certify that the above named material does hot contain free liquid as defined by 40 CFR Part 260.10 or any applicable ! <br /> t state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has belen properly described, <br /> C s' ied and packag , and is in proper con ' ' for tran ort 'on acco 'ng to applicable regulations. <br /> kuL L <br /> Generator Authorized Agent Name Signature a Shipment Date r <br /> s <br /> r. iTRANSPORTER . <br /> Truck No. <br /> Phone No. <br /> Transport Namev� v&�N. Driver Name (Print) Al I <br /> Address y Vehicle License No./State._ <br /> `� Vehicle Certification F <br /> I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> at the generator site listed above. out incident to the destinatiQrL destiny' listed below. <br /> Driver Signa re Shipment Date Driver Signatur Delivery Date <br /> � � I <br /> DESTINATION <br /> Site Name hone No. <br /> .Address <br /> I hereby certify that the above named material has been accepted and to the best of y kn wlodge the foregoing is true and accurate. <br /> e <br /> 3 Name of Authorized Agent Signature / Receipt Date <br /> 4 <br />' PASS CODE ' <br /> 1 7 0!66 0 BF1260-720 <br /> UNLOADING AREA COPY <br />