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;BSY.stems <br /> Ro TM <br /> NON-HAZARDOUSP <br /> WNING FERRIS INDUSTRIES S ECTAL WAS7E E MANIFEST <br /> GENERATOR <br /> L <br /> L Fas7nc - - 1049 E h Channel <br /> i�enerator Name Generating Location <br /> F; G Dox 55 1 t�' btockcor, Ca _ <br />{,ddress - Address µ �' <br /> - Zrc-,� <br /> one No"� r Phone No <br /> r g V Containers Type <br /> FI Waste Code D Drum <br /> Description of Waste Quanta Units No pe <br /> Elm C Carton <br /> B - Bag <br /> T -Truck <br /> ❑ I I i ❑ P Pounds <br /> +� Y Yards <br /> El ❑ s <br /> - O 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 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 /> Pc)naId I Pnnei�yr: <br /> L <br /> _ 4 � <br /> snerapr Authorized Agent Name Signature Shipment pate <br /> =SP <br /> Y <br />]uck No 9� Phone No <br /> 1'^ /I ror,Ifl�r•, 4 C I rti L: ` C <br />-ansporter Name h1 - Driver Name (Prtnt�.� ! ��) <br /> dress = 4 00 !lana, 5 c r c-eI - <br /> " s Vehicle License No <br /> Vehicle Certific tion <br /> lerebycert that the ove named material was p=cked up l hereby c ify that the abamed material was delivered with <br /> the enemator site li d above/ Y ot�E tnctd nt tsr�he desU tion listed below <br /> ver Signature Shipment Date JDaver Signature Delivery Date <br /> DESTINATION <br /> Name , Vasco Road Sanitary L 5ndf i l l <br /> Phone No a —� <br /> r K <br /> fdresS J_ V cs r I <br />�reby certify that the above named material has been'accepted and to the best of my knowledge the foregoin,g is true and accurate <br /> r E <br /> Ftuthonzed A 9 ent SF nature Receipt Date <br /> ' PASS CODE ' <br /> e " BF1260 720 <br />