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3 <br /> Waste «0: 1 :C.-r 100q042 <br /> No <br /> 1� Systems TM <br /> ROWNING FERRIS INDUSTRIES NO' N-HAZARDOUS SPECIAL LWASTE MANIFEST <br /> 411 Mid Cal ,Lea'inq 1549 E Channel St - <br /> enerator Name Generating Location <br /> P . 0 Sox 55103 Etoci- ccr Ca <br />�ddress Address <br /> ?S205 <br /> d 5 1 3 IE t ?� 5 <br /> hone N( Phone N-o — <br /> C .,Aj <br /> BF] Waste Code 4 1 0 ° Containers Type <br /> Description of Waste Quantay Units No Type D - Drum <br /> u7e5el Contaminated Soil 9 ❑ m C - Carton <br /> u B Bag <br /> El �^ ❑ T - Truck <br /> I FT-1 W P - Pounds <br /> " Y - Yards <br /> -' � � � �t l ❑ 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 far-4 i <br /> �r ansportatior� according to applicable regulations <br /> l <br /> L <br /> 1 � � <br /> nerator Authorized Agent Name Signature Shipment Date <br /> Ulf <br /> luck No Phone No <br /> Transporter Name 11 D Environmental Sere i r es- Driver Name (Print) ___ T; <br /> dress '.100 Ma,no:- tirrlc_et <br /> L Vehicle License No /State <br /> Vehicle Certification 7�2 <br /> lereby certify that the above named maternal was picked up I hereby certify that the above named material was delivered with <br /> t the generator"site listed above out incident to the destination liste below <br /> r D 9 z <br />)rover Srgnature Sho-pment Date Driver Signatur Delivery Date <br /> DESTINATIOU <br /> eName j Asn Cns � S�n� trr• I_or'i3Fi1 �I i _ l t] <br /> Phone No —� <br />[dress' � IiS� 1 ���=r.- r" - ' �i ' � -� p r`�`l�rc ['•a -ri� �� i�! <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 /> r <br /> Authorized A ent Si nature Receipt Date <br /> r <br /> PASS CODE <br /> 6 3F1260 720 <br /> GENERATOR RETAIN <br /> i <br />