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P,ROWNING-FERRIS <br /> w r. as e HF__IAcc No_ 1 00904 2 No <br /> XT <br /> Systems TM <br /> INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • <br /> y - tolij Cal I_eaZ`inct _ ; 549 E. Cloanrrei St <br /> enerator Name V Generating Location <br />� <br /> ddress <br /> P C Box 55103 Address Stockt-on C5� <br /> f ' <br /> "C� 4520E <br /> tone'No�_[=_14 1 -15]_11 Phone No*' <br /> 3F1 WasteCodeC A 4 0P___] S 1 8 Containers Type <br /> Description of Waste Quantic Units No Type D prom <br /> r I� J <br /> S <br /> Diesel Cvntirr: f natecE So—t1 C Carton <br /> B Bag <br /> T Truck <br />' El m 1:1 <br /> P - Pounds <br /> Y -Yards <br /> 0 Other <br /> } s i <br /> E 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 defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br />' classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> r <br /> nerator Authorized Agent Name Signature Shipment Date <br /> 0 <br />�uckNo �{T — 3 � �5,_ i5 FCg-Q3 i ` <br /> Phone No <br /> ransporter Name m D Er`'v-i r^onnien�.a Ser v i ces <br /> Driver Name (Print) v <br /> dress ' C+p Peat' sr 5r ,` r - - Vehicle License No (State 5 75,,,,- /C D <br /> Vehicle Certification <br /> lereby certify that the above named material was picked up I hereby certify that the above named matenat was delivered with <br /> t the generator stte listed above out incident to the destination listed below <br /> river S gnat... Shipment Date Driver Signature Delivery Date — <br /> DESTINATION <br /> r <br /> e Name Jac ,rt Satll tial' ! L,=—,dj rj 1 1 3 t <br /> Phone No - <br /> 4 !'�,'i 1 rye . C— 1 V r MCZ <br /> ddress <br /> lereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true a d accurate <br /> af9MWAuthorized Agent Signature Receisr Dale i <br /> r <br /> PASS CODE <br /> fi BFl260 720 <br /> GENERATOR RETAIN <br />