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611 - <br /> Waste R 8F1 kt=ct No 9oso4g <br /> S 'M t3ROWNlNG-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • <br /> Mica Cal Leat ;n� 1645 F Channel St . <br /> Generator Name c � Generating Location <br /> r- C. Box 55103 Stocktor) Ca <br />�ddress Address <br /> =t-nftrtprl - ._Ca _ '?S4t�5 I <br /> hone No- - - -'Phone'No <br /> 5 <br /> C 0 9 x 1 9 2 3 9 S <br /> BFI Waste Code Containers Type <br /> Description of Waste Quantity Units No Type D - Drum j <br /> 11 r <br /> �'�P CnotcfTl'1n8ts?C.I Sr"l u S - Bag i <br /> m T - Truck <br /> El El <br /> P - Pounds j <br /> Y - Yards <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 /> I classified and packaged, and is in proper condition for,t% ransportation accor�dmg to applicable regulations i <br /> _,r,-3l _ K , P ir,�l:ar't ,�� 1 r <br /> Generator Authorized Agent Name Signature Shipment Date <br /> e , <br /> truck No __..� Phone No 5 6 -° <br /> P Esnvi r c,i-ment%l Ser\, ces <br /> Transporter Name -' Driver Name (Pant) <br /> Mi ,or� 3t-ri=ft:ddress Vehicle License No/State Irl <br /> r J Vehicle Certification <br /> hereby certify that the above named material was picked up i hereby certify that the above named material was delivered with- <br /> at the generator site listed above out incident to the destination listed below <br /> I j ry L_ <br /> nv r- i nal re Shipment Date Dnv r S+gnature - De very Date <br /> DESTINATION1 <br /> Ve rn Road Sanitary L-in-Ifi l l1 q H <br /> Iite Name _ Phone No �— <br /> ddress Z'cc) 1'oe;2 Liv -trF_ { c 5i, <br /> , y <br /> hereby certiiv that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate 4�f <br /> r <br /> a � <br /> r= 'fi <br /> Authorized Agent Sonature Receipt Date ils <br /> } <br /> PASS CODE I <br />�lBB BF1260 720 1 <br /> ' � s <br /> ' GEN-ERATOR RETAIN <br />