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91Waste <br /> SystemsTM <br /> t?�OIMlIttiO FERRIS IWDt1STRIES N6M- AM"nisilCIAL WAST <br /> Generator Name 5A V7A LC, 00fCA, t t4jA)Z C .'IGenerating Location ! �J <br /> Address 1 / (=A s T- t Av t F��F n ff Address S-T Ltl;cr A/ �A . <br /> Plane No. Phone No. I I I I <br /> BFI Waste Code m FTFI Containers Type <br /> Description of Waste l]uanti Units No. T 0-Drum <br /> - oma B-Carton <br /> Bag <br /> B-� <br /> Q De^�O 4 u T-Truck <br /> ❑ m F] P Pounds <br /> Y-Yards <br /> El 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 not a 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 condition for transportation according to applicable regulations. <br /> Generator Authorized Agent Name signature Shonent Date <br /> TRANSPORTER <br /> Truck No. -Z �P D Phone No.. '74i) -l V -jr- ry� c <br /> T 3 <br /> Transporteer Named- <br /> `a /AA > ItcdLll-1-I, Driver Name (Print) -e',' !��-A/ <br /> Address An✓ a/ Ll lItea,y C A Vehicle License No./State tl?n ) Z <br /> Vehicle Certification -'t}11 S T 7 <br /> 1 hereby certify that the above named material was picked up I hereby certify that the above named material was delivered witfr <br /> at the generator site listed above. out incident to the destination listed below. <br /> omen sipnaYn shows Date Driver Sgnatws De mM Dere <br /> DESTINATION <br /> rr�te,, <br /> Site Name Phone No. l�— <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the for 'n/(gg--f� true and accurate. <br /> Name of Authorized Agent sionzitunt u Receipt Date <br /> PASS CODE <br /> 10/88 <br /> a i <br /> GENERATOR RETAIN <br />