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1 <br /> OSystems <br /> 'Waste_ -- - BFI -Acct--,No` sij%3 01:! = -- - _ -==No=9079 $ 9----TM <br />;ROWNING-IFERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Mid Cal Leasing 1649 E. Channel St - <br /> ddress Address <br /> Generator Name Generating Location <br />� P O Box 5S103 Stockton . Ga <br /> ` Stockton , Ga - 95205 <br /> thone No — IIIJ. Phone NoI 111 91 <br /> FI Waste Cade <br /> m 1 8 5 Containers Type <br /> Description of Waste Quantity Units No Type D - Drum <br /> Diesel Contaminated Soil C -Carton <br /> �-8 1 a T B - Bag <br />' T -Truck <br /> FTI ❑ ❑ P - Pounds <br /> Y - Yards <br /> T-F-1 ❑ ❑ 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 condition fgt' ransportati actor ing to applicable regulations <br /> r 1 <br /> enerator Authorized Agent Name Signature Shipment Date <br /> T cd yr rev • � •h Gt 3�' is sr <br /> �Z-7 �f7s 916 668-9316ruck No Phone No <br /> M P EnvironiTrental Services <br /> ransporter Name Driver Name (Print) d1 - <br /> 3400 Manor Street _ <br /> iddress Vehicle License No/State <br /> PaI- ern:f -_4 <br /> Vehicle Certification <br />'Hereby certify that the above named material was picked up I herebycertify that the above named material w <br /> Y as delivered with- <br /> it the generator site listed above out Incident to the destination listed below <br /> 1Z 1Z <br />)river Signat a Shipment Dale Driver Signatu� Delivery Date <br /> Road S ni tav, l_ ;�� l IJ c; f <br /> to Name Phone No �- <br /> aOOI V;-sco Road , ► ,.ger > -e r"-: <br /> S 55n <br /> address <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 /> :E P:fAZ.th:.::,,�z.dAg.nt Si nature - receipt Dale <br /> PASS CODE <br /> 06 BF1260 724 <br /> GENERATOR RETAIN <br />