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Waste 9F1 Acct No 100"11 No 90797 <br />_%MC� <br /> Systems rµ _ <br /> iROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> • <br /> a <br /> Mid Cal Leasing 1 '_ 19 E _ C,-,annel �:t <br /> enerator Name Generating Location <br /> G. Box '551 CQ <br />�iddress l Address <br /> It roc4�tor) , Ca . 95205 <br /> hone No ='- - r211 6 10 r <br /> Phone No <br /> F-C 1 _ 7 4 5 Containers Type <br /> BFI Waste Code L f ! � - <br /> Description of Waste Ouanttty Units No T pe D - Crum <br /> UC - Carton <br /> ig hEl Garttat�tir,ate�i Sc„ l P El m <br /> B - Bag <br /> T - Truck <br />' ❑ m ❑ P - Pounds <br /> Y - Yards <br /> w El m Fl O- Other <br /> I hereby certify that-the 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 fo" ransportation actor Ing to applicable regulations <br /> pcna I d K Pi r,enar <br /> generator Authorized Agent Name Signature Shipment Date <br /> T RAN—SP <br /> s - <br /> ruck No -ate J/�G .., Phone No <br /> M f7 F�ormertit�l Serb fres <br /> Transporter Name Driver Name (Print) ; rii E-, <br /> 3 1 F 0 Ma. o1, Strwwc <br /> Iddress Vehicle License No/State <br /> L , <br /> Vehicle Certification <br /> lereby certify that the above named material was picked up I hereby certify,that the above named material was delivered with- <br /> it the generator'site Itstedlabove out incident to the destination listed below <br />)aver Signature t , Shipment Date Der 5+gn iLfr Z� Delivery Date <br /> DESTINATION <br /> Vasco Road Sanitar'v Landfill <br /> ddress <br /> Ite Name Phone No �- . <br /> +01 �`asco 3f:`�tf L-ivarmore' Ca '155( <br /> . <br /> ' <br /> z <br /> ereby certify that the above named material has been accepts d and to the best of my knowledge the foregoing is true and accurate <br /> Authorized A ent S, nature Receipt Date <br /> r , <br /> t <br /> PASS CODE <br />�86 BFf260 720 <br /> CENERATi RETAIN <br />