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vaste <br /> Qcnn BFI Acct N 1009042- No .7opJ19 <br /> i;aSystems TM <br /> OWNING-FERFt151NpUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • <br /> ; A r <br /> Aerator Narne Mid Cal t o a s n Generating Location Cha.- <br /> F dress <br /> PO So>( 55103 Address StocLeton Ca <br /> tone No rl Phone No �— <br /> A ; Containers Type <br /> I Waste Code D Drum <br /> Description of Waste Quanttt Units No Tae <br /> m C Carton <br /> El <br /> B Bag <br />' T Truck <br /> ❑ W � P Pounds <br /> Y - Yards <br /> ❑ m ❑ O Other <br />' I hereby certify that the above named material does not contain tree liquid as defined by 40 CFR Part 260 10 or any applicable <br />' state law, is not a hazardous waste as defined by 40 CPR Part 261 or any applicable state law, has been property described, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> -e r- � 1d F Plrrahc <br /> ,P ator Authorized Agent Name Signature Shipment Date <br /> 7r�/ <br /> Ick No — cV Phone No <br /> Driver Name (Print) r <br /> fir.\�, r �3nrir.-f'1tc'x� Y-^.1� . l �i-� <br />('nspor-ter Name <br /> 3400 N1ankDr yrr �i-:-2r <br /> dress Vehicle License No/State <br />!ereby <br /> ?3"2 Vehicle Certification <br /> certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> the geinerator site listed above ,but incident to the destination listed below <br /> Iver Signature Shipment Date '` Driver gnature Delivery Date tCC <br /> DESTINATION <br /> Name aaco Road Sanitary Landfill Phone No <br /> dress `s 0", , It 0Cc F c-Uw L� .� rric; La 6 1 �5t) <br /> Ireby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> F..f Author zed A ent Si nature Receipt Dale <br /> PASS CODE <br /> 8F1260 7,20 <br /> GENERATOR RETAIN <br />