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Waste No. 913396 <br /> Systems T NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> BROWNING-FERRIS INDUSTRIES <br /> GENERATOR <br /> Generator NameU�K,ii�l7 Generating Location <br /> Address sf /yIr Address <br /> Phone No. 3 7 3 Phone No. <br /> BFI Waste CodeFC `� �t O ,5 Q 3 / L I © l Containers Type <br /> Description of Waste Quantity Units No. T e D- Drum <br /> m Cartoi <br /> B •Bag <br /> T -Truck <br /> ! ET-1 ❑ m El P-Pounc <br /> Y-YardE <br /> ❑ m El -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 applicabl( <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described <br /> classifie and packaged, and is in proper condition for transportation according to applicable regulations. <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. ✓ �-� Phone No. <br /> Transporter Name r'Driver Name (Print) <br /> Address Vehicle License No./State <br /> Vehicle Certification <br /> I hereby certify that the above/named material was picked up I hereby cer_tif that theme above named material was delivered w <br /> at the generator•site fsted above. out incident o th dstination listed below. <br /> Driver Signature Shipment Date Dr' er Signature Delivery Date <br /> �% <br /> DESTINATION <br /> Site Name Phone No. <br /> 77 <br /> f- <br /> �— <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 accure <br /> Name of Authorized Agent Si nature —, Receipt Date <br /> PASS CODE <br /> BFI26, <br /> 10/86 <br /> nrn1r-MATllf1 rlj—TAIAT <br />