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I -1 <br /> Waste- -, _ � -- --- 131"I-= Air 1---- � - - No - V O � 0 4�- - w� <br /> ` <br /> inuSystems TM <br />',BROWNING FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> WGenerator Name 'fin d Ca Le-asng Generating Location 164 9 Chartine f St - <br /> 1 <br /> Address P 0' Pax 55103 Stockton , Ca <br /> Address <br /> Cr t_0r, Ca 95-105 <br /> Fone-No EI�— 4 6 - 0 9 <br /> Phone No <br /> BFI Waste Code 4 Ct 1 S $ 9 4-M Containers Type <br /> Description of Waste Quantity Units No T e D - Drum <br /> C - carton <br /> I it Kesel Contain t ntoti Soy 1 1 ❑1 m B - Bag <br /> m T -Truck <br /> ET-1 0El <br /> P - Pounds <br /> Y - Yards <br /> Elm ❑ O- Other <br /> I 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 /> Iclassified and packaged, and is In proper condltton for- ansportatio -according to applicable regulations <br /> ��onald 1-, k-1ne is l <br /> Generator Authorized Agent Name Signature Shtpmenl Date <br />�ruclC No �� 7� � Phone No 3 1 0 b 5 0 -Q 3 1 S <br /> Transporter f'1 P Envronmc-ntal Services G <br /> P Driver Name (Print) <br /> ddress 2100 rl rir r St.t-eet <br /> I <br /> Vehicle License No /State <br /> Vehicle Certification <br /> 'hereby certify that the abo o named material was picked up I hereby cert fy that the above named material was delivered with- <br /> at the generator site llste above out mciden o the de� a`tion listed below <br /> Driver Signature Shipment Date Driver Signature Delivery Date <br /> r <br /> '+�r3tiC- P rad Sante rary L-r�-1f� �— <br /> Site Name Phone No - <br /> iddress .700 '- `Wo load LivArrriflre f 5 9455 13 <br /> hereby certify that The above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> of Authorized A en+ Si nature <br /> Receipt Data <br /> PASS CODE <br />�18fi BF1260 720 <br /> GENERATOR RETAIN <br />