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I Waste- BFI Acct No. 1009042 No 906034 104OWNING-IFERRIS Systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST INDUSl'RiES • Mid Gal Leas i rg i 6i y E I,ar,n� 1 ;,t (enerator Name Generating Location 11 0 - Box 55103 atocl ton , Ca Iddress Address Dt_csc l:tnn ca . 9b205 !] 95 3 6 � hone No _ _ __ -- Phone No C A 4 t) 1 9 1 l t 9 ? j 3 7 9 5 Containers Type FI Waste Code L~..,LJ D - Drum Description of Waste Quantit Units No T e C - Carton 0 t G ,t~ 1 Can C ani i nated Sol l ! 6 T B - Bag T -Truck ❑ m ❑ P - Pounds Y - Yards Elm ElO- Other I I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, ' classified and packaged, and is in properfcod+tion fort nsportatton accords g,to applicable regulations 11011"AZd It R-inehst,i: T GG i Generator Authorized Agent Name Signature Shipment Date I TRANSPORTER `i I 'Truck Na ` Phone No 1 b a 6 6 9 3 1 6 } l Transporter Name F' Fnv ► r cinmtn> d 1 Set v7 ces Driver Name (Print) lAddress s A ki 1' hies r i c)r S L r,e e t Vehicle License No/State r/ ucl1,&rSf le Id , �=l 93308 Vehicle Certification I hereby certify that a above named material was picked up I hereby certify that the above named material was delivered with- at qr�ge,;t rator s iste above out incident to the de tinatson listed below � Y' ff Driver ygnatuie Shipment Date ❑ ver Sig ure Delivery Date DESTINATION Site Name ' Road 3anzt_ar V Landt-1 1 1 Phone No 1 0 _ 4 4 7 y 1 Address A00I Vasco Road , Liverrnor e , 9 4 b 5 0 I hereby certify that the above named material has been accepted and to the best of my knowledge the fore itag-i!§-true and accurate ry] of Authonzed A ent Signature Receip Dat PASS CODE 10!86 BF1260 720 UNLOADING AREA COPY