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0WNING-F <br /> Waste BFJ Acct . No- 1009042 No 906045S]/Stel'Y1S '. NON-HAZARDOUS SPECIAL WASTE MANIFESTERRIS INDUSTRIES , <br /> • <br /> r7e <br /> Mid (,a 1 Lt=,awli-ig 1 *49 E l f)anrie I t_ i <br /> Generating Location <br /> P D Box 55103 <br /> idress Address <br /> ~ luc I,LGir , La 95205 <br /> one No Phone No T-1 <br /> 0 5 tl 9 $ 912 3 1 g 5 Containers Type <br /> I Waste Code � t lD- Drum <br /> Desch Quanttt Units No T pe tion of Waste C Carton <br /> l` ftil Goircarntr�ar_ed 5q7 I k s3 l�L l it B - Bag <br /> I 1 ❑ T -Truck <br /> El <br /> P - Pounds <br /> Y - Yards <br /> ❑ W ❑ O- Other <br />' I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 264 10 or any applicable <br /> stale law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> 1 classified and packaged, and is in proper ditlon fa� nsporiatio ccordin�10 applicable regulations <br /> I „i, I l h k� ir�ehart �....� �- <br /> neralor Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> I <br />'uck No Phone No 316 668-9316 <br /> Transporter Name P ti tv r^ot lrne:eta I iii' c e. Driver Name (Print) 4 �!` <br /> s i il(i Niciit,)r' St i eet <br /> dress Vehicle License No(State C/ <br /> t i�,117,t-s f i e I d , (,a 9 3 3 0 8 Vehicle Certification <br /> tereby 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 /> 2 / 10 9 1 ZT�j <br /> driver Signatu Shipment Date Driver Signatur Delivery Date <br /> DESTINATION <br /> Vci Road Scir)-i Cai,y Lartdt i 11 5 10 — 4 4 0 4 9 i <br /> Site Name Phone No <br /> Ldress 4001 V,=iso r Road , Livermore , Ca <br /> I <br /> hereby certify that the above named material has been accepted and to the best of rBy'knowledge the foregoing Is true and accurate <br /> r �!f//- <br /> .�-- , <br /> f Authorized A enl Signature Receipt Date <br /> PASS CODE <br /> r <br /> � BFI260 720 <br /> UNLOADING AREA COPY <br /> f <br />