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WiWSystems <br /> aste __ -_ _ 906049- -8FIAcct _ N0- 1005042 No — <br /> rM' PE BROWNING FERRIS INDUSTRIES NON-HAZARDOUS S SPECIAL WASTE MANIFEST <br /> M , d C�l Leas,rig <br /> Generator Name Generating Lgt fiolll <br /> P ILt Box 55 i 0s <br />'Address Address <br /> ­�nckron Ca _ 95205 <br /> r _I T—] <br />'Phone Na C 9 417 <br /> Phone N ' <br /> F_C_FA__j <br /> �� Containers Type <br /> BFI Waste Code <br /> Description oET-1 r LJ 1 - 1 1-1 <br /> f Waste Quantrt Unit$ No T D - Drum <br /> D <br /> 7 esel rcntarni nated So-i l ° Li m C- Carton <br /> B - Bag <br /> T� T - Truck <br /> 11 II P - Pounds <br /> Y - Yards <br /> ❑ (� ❑ O- Other t <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 condition fortransportation according to applicable regulations <br /> t ''1 <br /> h RinFh3rr �----� i fJ <br /> C <br /> enerator Authonzed Agent Name Signature Shrpment Date <br /> 4 1 h 568—g3 'f 6 <br /> ruck No � � � S� Phone No <br /> Transporter Name t� F En�� ronr=ientQl Ser`ri cep 6� <br /> Driver Name (Print) +� <br /> ddress 400 <br /> I <br /> Vehicle License No/State U <br /> M9 S,2 0 P <br /> Vehicle Certification <br /> hereby certify that the above named material was picked up 1 hereby certify that the above named material was delivered with- <br /> at tl}e generator site fisted above out incident to the desti ation listed below <br /> Driver gnature Shi ment Date Driver Signa ure Delivery Date <br /> e <br /> 0 0 <br /> ` , Road o�d Sinn rl� <br /> tery andf� `t � <br /> to Name uPhone No _ <br /> LL '1.1 '1 E=1 <br /> 0ri1 va- _Sco Road Lnver•n,ore . Ga _ 94550 <br /> ddress <br /> Iereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> "I I I =1 <br /> f Authorized Agent F -Signature Receipt Date <br /> PASS CODE _ <br /> 186 EF1260 p <br /> GENERATOR RETAIN <br />