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Waste1009042907983 <br /> .� BFI Acct - N©_ No <br /> TM <br /> f Systems <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> MId C55 1 LectSrtrig 1649 C Ch � 1 :>L <br /> Generator Name Generating Location cat)rl <br /> F 0 Box 551 0 , 3tockt,c)r) , +~� <br /> dress Address <br /> stc ckroo , cc 95205 <br /> J <br /> one No Phone No �— <br />�I Waste Code 7 4 19 15 1 Containers Type <br /> Description of Waste Quandt Units No Type D - Drum <br /> 1 ❑l m C- Carton <br /> Cot-IT �tin� atc� <br /> neSca71 B Bag <br /> m T - Truck <br /> F-1 ❑ <br /> P Pounds <br /> Y -Yards <br /> ❑ ! ❑ O- Other <br /> t hereby certify that the above named material does not contain free liquid as defined by 40 CFA Part 260W10 or 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 in grope c ditionrfTran l accor g to applicable regulations <br /> R-ine1)ajr�t - <br /> for Authorized Agent Name Signature Shipment Date <br /> _ 1 <br /> luck No Phone No 9 1 6 b b(3 _g 3 i B <br /> hl P &)vtronm+✓ntal , r ,ltce� � e- <br /> ansporter Name + Driver Name (Print) yi fr <br /> scl 0() Manor, 2 ( reef /� Q <br /> ddress Vehicle License No/State J <br /> ti�l�i✓r ,f t�1cl , t�a 9 130 <br /> Vehicle Certification L� <br /> ereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> it <br /> the generator site listed above out incident to the destination listed below <br /> I d_ 6� __ <br /> ." d Z z <br />)river Signa[1016Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> te Name <br /> `J:I-c 0 Rnad Sar1ii tar y Land1 11 <br /> Phone No <br /> I <br /> a (r(i 1 Vast.o K'06 J , L7ver more , C,=, 94c50 <br />)ddress <br />�iereby certify that the above named material has been accepted and to the best of my j naw dge the fore9ping1s true and accurate <br /> Ela� <br /> Authorized Agent Si nature / F Receipt Date <br /> PASb CODE 1 <br /> BFI260 720 <br /> UNLOADING AREA COPY <br />