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Waste No. 913397 <br /> Systems TM <br /> BROWNING-FERRIS INDUSTRIES NON HAZARDOUS SPECIAL WASTE GENERATOR <br /> Senerator Name / ��>u/'� �k k�'�l7 Generating Location'?�679 C'C fly /N��GC cX.J <br /> Address ' � Address <br /> Phone No. 2 U � J Phone No. �— <br /> (' CJ Z/ / U �/ '� 4 � ,U Containers Type <br /> BFI Waste Code <br /> Description of Waste QuantityUnits No. T Q D-Drum <br /> C-Cartor <br /> a a m B - Bag <br /> T -Truck <br /> ❑ m ❑ P -Pound: <br /> Y -Yards <br /> FTTI 1-1m 1:1O-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 defin9d by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classifie"nd packaged, and is inrproper condition for transportation according to applicable regulations. <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. _-D L) I Phone No. <br /> Transporter Name —f r'1�2 it R-A Driver Name (Print) <br /> Address G t' Z Vehicle License No./State 3�Z�7 d <br /> Vehicle Certification <br /> I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered wit <br /> at the generator site listed above. out incident to the destination listed below. <br /> tel//` <br /> Driver 'gna re Shipment Dale DrivafSignature Delivery Date <br /> DESTINATION <br /> Site Name Phone No. �— <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best o now d th oing is true and accuratt <br /> 6 c <br /> Name of Authorized Agent Signature 1000, Recelp Date <br /> PASS CODE <br /> v.. BF1260 <br /> 10/86 <br /> GENE' 'TOR RETAIN <br />