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1 ti <br /> Waste . 95077T t �` <br /> Systems TM , <br /> tHOtJ3TRtBe NON-HAZARDOUS SPECIAL WASTE MAN{i= " <br /> GENERATOR <br /> Generator Name Generating Location <br /> Address Address "• ' <br /> Phone No. Phone No. �— <br /> BFI Waste Code m t _J� —�] Containers Type <br /> Descri tion -'Waste Quantittv units No. T -Drum <br /> C <br /> C•Carton <br /> E FT 8-Bag <br /> F--F1 <br /> P -Truck <br /> r <br /> Y•Yards <br /> l ❑ m F] 0-Other <br /> I hereby certify that the above named material does not contain free liquidas definedby140 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 property described, <br /> classified apd packaged, and is in proper condition for transportation according to applicable regulations.' <br /> K ;h,t. <br /> Generate Aulla Mwne Signature <br /> TRANSPORTER <br /> Truck No. Phone No. <br /> Transporter Name ! 4 t. r u Driver Name(Print) <br /> Address Vehicle License No./State <br /> r� 1 Vehicle Certification <br /> i hereby certify that the above named material was picked up I hereby certify that the above ipmed material was delivered wW <br /> at the generator site listed above. out incident to the destination listed below. <br /> i { 1 1 % 1 ^ ' L'j—/ 1 <br /> Drive rule <br /> Sp^a Shipmenl Date Driver a Deevery Date <br /> DESTINATlOt4 <br /> Site Name Phone No. �— <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of qy knowledge the foregoing is true and accurate. <br /> Name of Authorized A t nat� ReceiW DMe <br /> PASS 09M <br /> 70198 BF128672a <br /> GENERATOR RETAIN <br />