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i f r i ----- BI Acct N'o 100904 No �QC� QAL - _ - Systems TM OWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE rMANIFEST s 'z�, 16 43 Q E c h a r-'r+ ! t- �enerator Name Generating Loc:{son r U_ Bo 55 103 S�ackton , Ca - dress Address C Z: j one No Phone No r q n i g 7 132 Containers Type I Waste Code 1 - D Description of Waste Quantity Units No T pe C ' Drum ❑ m C Carlon ' T'- Truck ❑ m ❑ P - Pounds Y Yards ❑ m ❑ O Other E hereby certify that the above named material does not containfree liquid as defined by 40 CFR Part 260 10 or any applicable state law, Is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, I classified and packaged, and is in proper condition for transportation aG ording€to applicable regulations r ,7Z0 i � k _ p i4'Jt41 t , erator Authorized Agent Name Signature Shipment Date 41 ,�'°'u H' a c O I VA ck Nof Phone No ? 1 6 6 5 2--9 3 1 & iE r fl ronrn n r ansporter Name c i�4 t ` Driver Name (Print) 1 !/ dress - Vehicle License No/State G� z I V } -1 _; r` g;308 Vehicle Certification I i lereby certify that the above named material was picked up i hereby certify that the above named material was delivered with- I the enerator site listed bove e out incident to the destination listed below Iver Signature Shipment Dale r t a ure Delivery Date rName Vasco Road Sanitary Landf i l ! _ Phone No 6 0 — 4 7 0 1 In-01 e �-SOC, h =c�G t ever Cry ]dress - g C �reby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate El::[:= I Authorized A ent Si nature Receipt Date I PASS CODE 5 DFI260 720 GEN,iFF;A OR PETAIN