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l Waste BFT Acct _ No 10t79a4z �0 907980 4 -Systems TU ROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST • Mica Cal Leaz_ inc, 1649 E _ enerator Name - - - Generating Location ° P 0 Box 55103 S'�OCnCon C � Iddress ' Address '+ aces - {hone No i - Phone No _LT_T__1 1- - 1 - 1 r �, f9F, I I 31`1 Waste Code _ Containers Type ' Description of Waste Quandt Units No nB D -Drum ! ��1 Contarn-inatc' 'c = d m C - Carton � - Bag ' ElL _. i i 11T Truck P - Pounas ' Y Yards _ x � z _ ❑ m � O Other i I+ rr 1 hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 26010 or any applicable ; state law, 1s not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to applicable regulations enerator Authorized Agent Name Signature Shipment Date • �uck No 7 1 - t✓ J - Phone Na t11 Envz rca-�rT�� nfi I = rv� cam_ ransporter Name Driver Name (Print) 11dressVehicle License No(State Vehicle Certification le'rebyfcertify that the above named material was picked up I hereby certify that the above named material was delivered with u t the generator site isted above out Incident to the destination listed below rive`Signature Shipment Date Driver Srgoture Delivery Date i DESTINATION V SCL3 P'r, 3drSan, tary L�inrjf-111 to Name Phone No C T, �t j _ ..�r^rri W r c- r a Q ti F'S t`r dress _ r �ereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate , Authorized A ern Ss nature Receipt Hate 117 i PASS CODE _ 186 BF126C GENERATOR RETAIN