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0WNING- <br /> Waste BFI AccL . No. 1009042 No906044 <br /> F�]/Istems QUSTRIES TM NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> to • <br /> Mich Cal 1649 E chcjnne I st- <br /> enerator Name Generating Location <br /> 1' �t BOX 115103 Stnchtori , i a <br /> tress Address <br /> [ (;%-I tori , Ccs 95205 <br /> ine No 2 0 — ] 5 -3- 6 I ! ! 1 Phone No �T <br /> C AFT-ST---i 1 0 1 9 1 1 9 2 3 7 1 9M <br /> Waste Code Containers Type <br /> Description of Waste Quantic Units No Type D - Drum <br /> C- Carton <br /> #ji �-sGl Conr_clitInate;d Soo -1 f i3 � � 13 - Bag <br />' m T -Truck <br /> El El <br /> P - Pounds <br /> Y - Yards <br />' ❑ m El — <br /> OOther <br /> hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 Jor 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 to proper�c dation for Ersriation a cordispo ' o applicable regulations <br /> erator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> ck No Lr Jn Phone Nb ` 1 b_b U 8 -y 3 1 6 <br /> t1 , f_ ,, r� <br /> -1 i,c' [fient a 1 `Sc,--I,v i cl <br /> ransparter Name hin Driver Name (Pant} �)���`� 1� �')tl 1.;,)t-Il< <br /> �vlar7nr' :at: vb <br /> i L <br /> ress Vehicle License No/State <br /> L ca I a i'�:, f t= 1 d c 9 13 0 d Vehicle Certification <br /> Ireby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> t the genrator site listed above �} [� out Incident to the destination listed below <br /> roor Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> a aco Road Dan-1 ra r y I <And ff i I I 5 1 0 1l 4 ! + a � I <br /> ite Name Phone No <br /> +tilrll 'C4 haat# , l � v,�r�rri[o1�� , Ca 144ab0 <br /> dress <br /> ereby certify that the above named material has been accepted and to the 7bestp#- kn wledge the foregoing is true and accurate <br /> - <br /> Authorized A ent Signature Receipt Date <br /> -7 4j" <br /> PASS CODE <br /> 86 4 � IBF1260 720 <br /> UNLOADING AREA COPY <br />