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l Waste No. <br /> 15935 <br /> Systems TM NON-HAZARDOUS BROWNING-FERRIS INDUSTRIES SPECIAL WASTE E IVI/'"" NI EST <br /> GENERATOR: <br /> Generator Name Pi-MDUIC-r-S Cl'_`pfi'1111ti' Generating Location `;[Vf. <br /> Address 450 F._.,G2ZN1 L= Address <br /> . . 7 <br /> SAM �. <br /> Phone No.'�-1 Phone No. ' 3 , <br /> - BFI Waste Code C 01 11 O 1 1 `7 1 el T I 3 9 I I 3 I O I Containers Type <br /> Description of WasteQuantity Units No. Type D- Drum i <br /> y t C -Carton <br /> EF N1 T 8 - Bag., I <br /> A T -Truck <br /> Ej <br /> m 1:1P - Pounds <br /> Y•-Yards - <br /> ❑ m ❑ 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 conditi n for i sportation according to applicable regulations.: " <br /> a 10 i � Z <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. J`�f Phone No. k' `= % Vl S <br /> Transporter Name f G �'` —"� Driver Name (Print) �� <br /> Address �6 7Q 1� P�1 y� . Vehicle License NodState <br /> Vehicle Certification <br /> 1 hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> F <br /> at the generator site listed above. out incident to the destination listed below. <br /> Z ZT1 ' <br /> D�ign. Shipment Date: river Signa#ure Delivery Date <br /> .-r G <br /> DESTINATION <br /> Site Name Phone No. <br /> r , <br /> Address <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 /> N of Authorized Agent Signature, - Receipt Date <br /> PASS CODE <br /> J WW ";. SF1260.720 <br /> UNLOADING AREA COPY <br />