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s r <br /> waste,._ LF ! Acct ?40 i 0 0 9 0 42 No <br /> OW7 9 8 <br /> r Systems TM <br /> ROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> me <br /> • <br /> M,d Cal Le-asin- 1 6 9 r�hanne I 6C . <br /> enerator Name Generating Location <br /> c _ Box 55 t U ' s SItocl-tor-, <br />[ddress Jr Address <br /> k A <br /> aC�c!'r©ft . Ca 9S2i3D <br />'hone No N Phone No <br /> I Fr-TA-1 Containers Type <br /> FI Waste Code i r i D- Drum <br /> Description of Waste Quanta Units No T pe <br /> Ct7 ��e i Contam;nated Sot i TT 1 I ❑ m C- Carton <br /> _.J B - Bag <br />' T -Truck <br /> F-1 0 <br /> P Pounds� <br /> Y - Yards , <br /> 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 Jaw, 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 cbnditson for-transportation according to applicable regulations <br /> - - f <br /> = l � ti �{fir �t Dr <br /> — L— d , r <br /> r ` <br /> neralor Authorized Agent Name Signature Shipment Date <br /> • <br /> luck No *�rd Phone No - <br /> M P Envi r_lnrrt�rt=O Serv-icr== <br />-ransporter Name Driver Name (Print) �,_,l_ <br />[dress­ ` - _ 'Vehicle License No /Statee <br /> Vehicle Certification <br /> lereby certify that the above named material was picked up '1 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 />`aver Signature I Shipment Date Dniver Signature Delivery Date <br /> DESTINATION <br /> vas,­) Road San-itary Landf-i1 -1 <br /> e Name Phone No �— <br /> 7 (tri �^C) rt,.JaC1 t -i v errnrn1, �7, S)7,0 <br />,ddress _ <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 /> Authorized A ent Signature Receipt Date <br /> PASS CODE <br /> 6 $ BF1260 720 <br />„ <br /> GENERATOR RETAIN <br />