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lJ t r V - <br /> L <br /> - Wast SFr Acct 140 10090.4 ' No o Qd q <br /> Systems TM <br /> ROWNING-FERRIS INDUSTRIES NON-HAZARDQUS SPECIAL WASTE MANIFEST <br /> enerator Name Generating Lg�ttior� ' <br /> P o _ Dox 55ia� <br /> ddress ' Address <br /> ^tocktori - Ca _ 9-,2175 <br /> hone No r Phone N <br /> C A 4 Containers Type <br /> y El, .1 <br /> Waste Code' <br /> 31= ❑ <br /> 1 ❑❑ ❑ D- Drum <br /> Description of Waste Quanta _ Units No Type <br /> o Elm1:1 C -Carton <br /> L`11E5Cl CCr1tarYt11'z�rCj ESo� l B - Bag <br /> T -Truck <br /> jr ❑ m ❑ P - Pounds <br /> Y -Yards <br /> w 3 _ - ❑ m ❑ O- Other,,' <br /> F <br /> 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 for1ransportation according to applicable regulations <br />�eneratOr Authorized Agent Name Signature Shipment Date <br /> F 668-9 1 5 <br /> ruck No � � Phone No _ <br /> f <br /> Transporter Name h3 P Er'tv`i ro�i��FntG� <br /> Driver Name (Print) <br /> ddress r - J - _ - - Vehicle License No/State �� <br /> _ nCT <br /> Vehicle Certification <br /> hereby certify that the'above named material was picked up I hereby certify that the above named material was del:vered with- <br /> at the,generator site Isted above out in�Wjent to the desti ation listed below <br /> L214 Z) <br /> /' n]Lri� <br /> lure Shi ment Date Driver Signature Delivery Date <br /> DESTINATION <br /> to Name Road S�a)� tary Land <br /> Phone No �— <br /> ddress ; �asc3 FL L <br /> ver^n,or Y., g4 c c rt <br />�ereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> uthor,zed A en1Si nature Receipt Date <br /> r u <br /> a <br /> 'r <br /> PASS CODE _ <br />�/86 ER260 j <br /> GENERATOR RETAIN <br />