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r� <br /> r Waste- 7 ' <br /> -___- - --_ __f3Fl—Acct —No 1009042 w _- -- ` _No _9(�79-f-,4 <br /> Systems TM <br /> ROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Mid C51 Leas-tnc <br /> 1643 >r Channel St _ <br /> enerator Name Generating Loca#ion <br />� <br /> P 0 sox 55102 Srockrcn Ca ddress Address <br /> 25205 <br /> hone No 0 — - _ <br /> Phone No <br /> BFl Waste Code C A 4 0 S 1 11 i Containers Type <br /> Description of Waste Quantity Units No T pe fl - Drum <br /> Ui ���1 Ccntanrinatad Sita1 8 ❑ m C - Carton <br /> I B - Bag <br />'I T -Truck <br /> ❑ t � ❑ 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 foHT <br /> nsportation according to applicable regulations <br /> generator Authorized Agent Name Signature Shipment Date <br /> MIF <br /> ruck No Phone No <br /> Transporter Name t Environmental Ser,vi ce^ <br /> Driver Name (Punt) _e <br /> Iddress ?400 Manor :It-remet Z <br /> Vehicle License No/State <br /> Vehicle Certification <br /> r <br /> hereby certify that the above named material was picked up i hereby certify that the above named material was delivered with- <br /> at the generator site listed above out incident to the destination llste below <br /> z 6 9 z <br /> Lr SignatureIsom Shipment Date Driver Signatur Delivery Date <br /> 9 � 0 <br /> I_and�i l l 0_=;ten �<�r�� -�rk <br /> Ile Name Phone No <br /> 001 V�� r rx a r� i -1,er~rrlO'-'^> C a � j55T0 <br />[dress <br />�ereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> f AuthorizedA eni Sr nature Receipt Date <br /> PASS CODE <br /> 186 BF1260 720 <br /> GENERATOR RETAIN <br />