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f Waste 9F1 AcCt ' No 100q�a� No <br /> Systems ,M I!ROWNING-IFERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> a. <br /> f <br /> Mid Cal �cd�lriG _ 1 649 E__ Cl,annal St _ <br /> 'enerator Name - Generating Location _ <br /> 0 So,' �5 "lui� .citOCi tGi� Ga <br />�ddress Address <br /> 95?05 <br /> F <br /> hone'fVo PhoneI oo <br /> 3F1 Waste Code m 9 1 3 7 5 <br /> Containers Type,- <br /> Description of Waste Quantity Units No T pe D - Drum <br /> g ❑ <br /> Dies-el Contaminated Soli C - Carton <br /> 1 B Bag <br /> T - Truck <br />' L_J FT-1 ❑ m ❑ P - Pounds <br /> Y - Yards <br /> 1 ' 1 11 D m el0-El Other , <br /> 1 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-for transportation according to applicable regulations <br /> ir <br /> t <br /> nerator Authorized Agent Name Signature Shipment Date <br /> ra <br /> luck No Phone No <br /> fey c' L=nv'trcnrrenr al Services �1�;r}1�1� <br />-ransporter Name Driver Name (Print) ... — 1 JAC>T _ <br /> 14 C'P t1a,ZC, Zt,-eerI _ <br />[dress- - - Vehicle License No/State�� �i Z(j - - <br /> Fla' = f I C- <br /> - r <br /> Vehicle Certification <br /> liereby certify that the above named material 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 listed below <br /> river Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> to Name'a ;co Read San j ra r`y Land if I I I <br /> 1 Phone No <br /> - <br /> r <br /> 11 ')01 VaSCD pot dVr- r rw Ccs 941757f� <br /> ddress <br />�ereby certify that the above named material has been accepted and to the best of my knowledge the foregoing s true and accurate <br /> Authorized Agent Sr nature Recerps Date <br /> 1 <br /> PASS CODE <br /> r6 BFI260 720 <br /> GENERATOR RETAIN <br />