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J - 5 Waste TM Systems N 8F1 Acct _ No. 100904'2 No 906048 BROWNING-FERRIS INDUSTRIES ON-HAZARDOUS SPECIAL WASTE MANIFEST Ce I Leas lric E l licyrlil I t Generator Name Generating Location 1649 !-' 55103 ' Address t3 cry `�zc,c 1- tcro , is Address 95205 I Phone No 0 # 6 5 3 6 Phone No � 1 5 MEE= 3 � 0 5 BFI Waste Code Containers Type ' Descrl tion of Waste Quantit Units No T e D - Drum iit ,✓.sal C ontariilriated Noll C - Carton I B - Bag ' ❑ T -Truck P - Pounds Y - Yards E:I= ❑ O- Other 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 prop?F c ndrtton fQ transportat n acco ding to applicable regulations t,r,tpa id h lrlc,tiat,C - Generator Authorized Agent Name Signature Shipment Date • � r Truck No Phone No 9 1 6 6b8- 9316 Transporter Name NI P f-'l v l i-c,n mer/t� I �r v I c , Driver Name (Print) t +400 Ncan.tr' SLr eet _ 1 Address Vehicle License No/State �I^sfl�lcl , Ca 93 iCJe, �— ' Vehicle Certification I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- at the generator site listed above out Incident to the destination listed below Shipment Date Dri er Signature Delivery Date DESTINATION+ • Site Name "'ICO Rndd _ri I tar V I ar)dt i l l Phone No b 1 0 Address :l Cita 1 V��c.� t��cf , L 1 vef,rt,r,r,,_ C a 914 5�u 1 ` �/ j 1 / � 1 I hereby certify that the above named material has been accepted and to the best of,my WoAedge the foregoing is true and accurate f ne of Authorized A ent Si nature Receipt Date �- 10166 PASS CODE I 8F1260 720 UNLOADING AREA COPY