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4 <br /> Waste---r—bF .= nct� rG ' bec,t�- = � ' o_a , /� <br /> .J V V "T-= <br /> Systems TM , T y <br /> `(IININGFERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE E MAN I FEST <br /> GENERATOR <br /> D'I'SC{ 'Cal c�SlnC I hkrt t;�- c• <br /> enerator Name Generating Location <br />�ddress P Q BOX 55103 Address StOCFtcr-t , Ca R _ <br /> hone No _ - <br /> Phone No <br /> FI Waste Code II n V { <br /> Containers Type <br /> I Description of Waste Quantity Units No Type D - Drum <br /> ❑ m C Carlon <br />■ C' t =~� � "_'�nt ,`_rr�� r- - *_t-: S: $ Bag <br /> T Truck <br /> ❑ � ❑ P Pounds <br /> ` Y Yards <br />�1 - ❑ L� J j� O Other <br /> I hereby certify that the above-named material does not contain free liquid as defined by 40 CPR Part 260 10 or any applicable <br /> Istate law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has beemproperly described, <br /> classified and packaged, and is In proper condition for transportation according to applicable regulations <br /> I Authorized Agent Name Signature 1 Shipment Date <br /> • <br /> luck No Phone No F' <br /> ns F c:i-, r <br /> Pro, r - m -t2a _= ca= 1 r" <br /> ansporter Name Driver Name (Print) ✓ �/1!/ ' d ,� <br /> 4 <br /> ^ ri 1(-, �/�CGJfJ <br /> U +15110r <br />.dress Vehicle License No/State <br /> e e— f Q` 0` Vehicle Certification <br /> iereby certify that above named material was picked up I hereby certify that the above named material was delivered'with- <br /> tj ge rator si Iste� above out incident to the de tinction listed below <br /> ver nature Shipment Dale D&ver S2grlature / Delivery Gate ' <br /> DESTINATION <br /> NameVasco Road ,,Sanz tar,y Lar- 1--1 11 _ 0 _ d 4 - 1 j 1 <br /> Phone No 1 _ <br /> G ! <br /> idress ? 0u 1 ua=ca Roams , Liver ,e cci ?115 5 C <br />�reby certify that the_above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> , <br /> s <br /> e of Authorized Agent Signature Receipt Date <br /> „ r r <br /> PASS CODE <br /> ° BF12GO 72U <br /> EME-RATOP I:,?CT611\1 <br />