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IOROWNING-FERRIS <br /> J <br /> N <br /> Waste SFI Acct - No 1009042 <br /> No 906049 <br /> Systems TM - <br /> INDUSTRIES ON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> l+�� ci C:= I Lea�-trsct <br /> Generator Name Generating L�Gat�ior� i - <br /> P ., Bo>, :35 1 0 3 <br /> Iddress Address <br /> .,t cit kLon , Ca 95205 <br /> �7 9 <br /> hone No —14 <br /> Phone NP <br /> A d <br /> JFl Waste Code � Ll 1 = Containers Type <br /> Description of Waste Quantit Urnt No T D- Drum <br /> L 7 1 Cc�rit nig nate So l � m � C - Carton <br /> B - Bag <br /> ❑ m T -Truck <br /> EL17M F-1 <br /> P - Pounds <br /> Y - Yards <br /> Elm [:1O 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 dfined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper c ditlon tO ansportatlon accords g to applicable regulations <br /> 1 ' <br /> ter„ alts 14 R-i ri"ha r t C- <br /> ator Authonzed Agent Name Signature Shipmehl Date <br /> gout I <br /> iU o 6 B 9316 <br /> ruck No `�; � S Phone No <br /> ransporter Name h1 P L r,,,,j r 01lrric!rlt I �F_I v 1 �t~_ !� <br /> Iddress <br /> Driver Name (Prin1) J '4 � [I /11 C.1 <br /> 1'1 t- U tnar�car �t_r� t 7C <br /> Vehicle License No/State moi /�} <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 /> al thwr generator sit Isted above out rnen# to the desi)yratron listed below <br /> zo <br /> Z9 � <br /> graver ignalure Shipment Date Dhver Signature Delivery Date <br /> DESTINATION <br /> -777 <br /> ite Name Vi ce F:na�i 56ri 7 t:ary I_crlJ f t 1 , <br /> Phone No <br /> Iddress 100 I Vcascca Road , L -tveroori GZ, �j 1 550 <br /> hereby certify that the above named material has been accepted and to the best ofowledge the foregoing is true and accurate <br /> _oi Authorize 11 A ent Si nature Receipt Date G <br /> PASS CODE <br />�t/ss r i / �J <br /> eFr260 720 <br /> NLOADING AREA COPY <br />