ARCHIVED REPORTS XR0001498 - Laserfiche WebLink

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" -- -;-� _ _a- 9(] 6023 =- - ---- I Accr N'3_ 1009012 :MROWNING-'IFERRIS Systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST iNDt1STRlES t3 alt tCl SYb1 revs-inc 3 (� /_k'ctlrl� l 7r 0 ddress Address generator Name Generating Location p' n Box 551Stockton , Ca ' -tga '0S � � I 'hone No r —� r Phone No 4 ' 7 r Containers Type I Waste Code � n� i , 5 D - Drum Description of Waste Quantity Units No Type C - Carton _ w t t_ r tc Ewad r I ' m B - Bag ' T - Truck ❑ m ❑ P - Pounds Y Yards TT7 ❑ m ❑ O- Other I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable state law, is not a hazardous wasto as defined by 40 CFR Part 261 or any applicable state law, has been properly descnbed, classified and packaged, and is in proper condition €or tansport to accorr ing to applicable regulations R orlc,1c: _ R�na1)F-, r t erator Authorized Agent Name Signature Shipment Date m.r I ck No `7' � -'�dr�rS� Phone No 3 i 6 -55"- 30 1 6 ! � . .. ._.__..-- 1 P Fr,v -onencej erw tc ansporter Name Driver Name (Print) �Jc�JCrC iN .i ,3 0 €�l a, ,�r S t r e,-t dress Vehicle License No/State z ! r _ r , i� Vehicle Certification i ereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- ! t the generator site listed above out incident to the destination listed below 3 Iver Sig t re ip D e rev elivery Date w y ,• r Namefasco Road Sar,- =ar`y Lan ifill _ Phone No [:4E4 7 2 400 V6szc Rca L �Vc-'-rnof-e ' C�. _ 4 5E 0 ddress i i �reby certify that the above named material,has been accepted and to the best of my knowledge the foregoing Is true and accurate i Authorized Agent Signature Fleceipt Date PASS CODE_ BF12fip 720 GENERATOR RRTA4IN �