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4 n L <br /> �oos04 2 _- - _ -_ -- - No 906038- - <br /> � S <br /> SystemsrM <br /> BROWNING-FERRIS NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> W F 151NDUSTRIES <br /> v � 049 E ..f,r,ne- 't <br /> Generator Name Generating Location <br /> Iddress <br /> F 0 Box 55103 tAddress Stockton , Ca <br /> (!�` rr-yy'�r'i _L�il , Ca CCU <br /> hone No Phone No <br /> r 4� <br /> FI Waste Code 4 131 9 t i a 7 C Containers -type v � <br /> Description of Waste Quantity Units No Type D - Drum <br /> C- Carton <br /> B - Bag <br /> ❑ m ❑ T - Pu <br /> ck <br /> � P - Pounds <br /> Y Yards <br /> 1 ❑ � a 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 is in proper coQditton for transportation according to applicable regulations <br /> fPonald Y Rinehart -/ l )~ <br /> enerator Authonzed Agent Name Signature Shipment Date <br /> Q <br /> Truck No Phone No 9 1 6 5 E 0-9.3 1 6 <br /> Grans orter Name V P Fnvz -onr,�ente I `'e'.-%,, cec Driver Name Print + ). <br /> ddress <br /> 3409 f�jnov atreeC /� <br /> rr�� i� Vehicle License No!State _,oI L f,L1a GrSf-i el ft C.5 9?3V4 <br /> Vehicle Certification <br />�ereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> it the generator site listed above ou incident to the destination listed below <br />)river Signature Shipment Date Driver signalure Delivery Date <br /> 'fasco Road Sanitary Landfill 1 0 — 4' 4 7 4 9 1 <br /> to Name Phone No <br /> kddress <br /> lereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> of AuthonzedA ant <br /> Si nature ReceipCc�e <br /> PASS CODE <br /> 186 BF1260 720 <br /> GENERATOR RETAIN <br />