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r Waste BF1 Acct _ No- 1009042 No 906036 <br /> Systems TM <br /> BR KING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> M-1d Cal Leasing Its�i ,3 � CF�artt¢e 1 ",L <br /> Generator Name Generating Location <br /> iddress <br /> F' J Brno 55103 Stocl�t,.in , ca <br /> Address <br /> ,i c�rl,Cc7n , <br /> Cc 9620b <br /> ��C3 99 — <br /> hone No LTJ Phone No �— <br /> C A 4 i3 a g 1 8 3 7 4 <br /> FI Waste Code Containers Type <br /> Description of Waste Quantit Units No Type D - Drum <br /> It iescl Cotil dti)inated Soo 1 11 8 m ( C - Carton <br /> �J B - Bag <br /> m � T -Truck <br /> P - Pounds <br /> Y - Yards <br /> ET_= ❑ ❑ 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 arl� applicable state law, has been properly described, <br /> classified and packaged, and is to proper dition r transporta ton acco ding to applicable regulations <br /> t ' <br /> r'c,rtold +, kineItar t � S _ <br /> for Authorized Agent Name Signature ! Shipment Date <br /> • <br /> ruck No Phone No 9 1 6 66d-9316 <br /> ransporter Name M P Environmental `j� e vr' �X <br /> Driver Name {Print} <br /> Iddress 34 GO Nc:irior, St Meer /���� <br /> Vehicle License No/State <br /> L�tl<�r 5h� Id , Ca 933ci6 <br /> Vehicle Certification <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> at the generator site listed above out Incident to the destination listed below <br /> Driver Signatuy <br /> Shipment Date ?e:r�Signfe <br /> Delivery Date <br /> J f 1 <br /> L <br />�ite Name V,-j-�cca Rc)ad Sar) t i-,ary Lrandt-t I i <br /> Phone No <br /> Address 4 UO I V.�sro koad , Li verri,ni e , t�a 04 550 <br /> ,A <br /> hereby certify that the above named material has been accepted and to the best of my kn ridge the foregoing is true and accurate <br /> VVIZ <br />#3of�Authorizedl A ent ' f Si nature Receipt Date <br /> �G L��� �5/"' t'A53 CODE <br /> ((( 8FI2fi0 720 <br /> UNLOA ING AREA COPY <br />