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1 <br /> 1 Waste— _ No- <br /> BFI c- ' t � 906030 <br /> aSystems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> IROWNING-IFERRIS INDUSTRIES <br /> O <br /> P""-1d C in 17a0 E C1) <br /> generator Name Generating Location <br /> ddress C Box 55 1 02 Address Stockton , C . _ <br /> hone No V t Phone No —L_ 1 --- <br /> FI Waste Cade � <br /> r' 0 g r 2 3 9 5 Containers Type <br /> Description of Waste Quantity Units No Type D - Druwt <br /> ❑ ElC - Carton <br /> � <br /> t1l-i ' cEL' t�"1 -� � -� B - Bag <br /> ❑ l� T -Truck <br /> F-1 <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 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 1s in proper condition for transportation cmc~ording to applicable regulations <br /> aerator Authorized Agent Name Signature Shipment Date <br /> k ® c <br />�uck No � rr9 Phone Na <br /> ( <br />- �' �r�ti'� r_.r,rr�G.ri�c � ��t'�/� r"�T <br /> ransporter Name Driver Name (Print) je- / 1/1 C �Ep ,.,_. 4rr)A/4:71 <br /> - <br />[dress ],A- 00 f'`'n�, r =� Vehicle License No/State y7 — ! U0 <br /> El r 1,e r sf' Ca '`3 0; Vehicle Certtfication <br />�ereby certify that the above named material was picked up l 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 /> nveir3gnature Shipment Date Driver Signature Delivery Date <br /> e NameVasco Road Sj t itary t_arrdf i I 1 Phone No S i s — 4 Q 7 4 g 1 <br /> ddress <br /> 4100, V r _, s .ar-Fiore 9 4 5 E 0 � <br /> I <br /> lereby certify that the above named material has been accepted and to the best of my knowledge the foregoing 1s true and accurate <br /> ft:A:u�thoozedA ent Si nalureReceipt Data <br /> PASS CODE <br /> Ic BF1260 720 <br /> GENERATOR PETA+fr1 <br />