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a ►`{ aste <br /> S stems TM No. 91&037' <br /> BROWNING-FERRIS INDUSTRIES NONHAZARDOUS , <br /> SPECIAL WASTE MANIFES t <br /> GENERATOR9 <br /> Generator Name as 5F/ Generating Location <br /> Address 450 E. GRXgT=, p0AD Address S1�ME <br /> 1' 3. 351 9 <br /> h <br /> Phone No. <br /> BFI Waste Cade +� v t7 �( z 3 j 3 b Containers Type <br /> rr f <br /> Description of Waste Ltuantit Units No. ,T�e, D-Drum <br /> Sit �a'lPos f ` $ "j'-+ C-Cartof <br /> B-Bag i <br /> - � T -Truck <br /> mP -Pound. <br /> Y Yards <br />�.. ❑ m ❑ O-Other <br /> �l 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 improper Condit' fortrlportation according to applicable regulations. <br /> BCB PAGERMM, PIANT 1AGER :: ld . i ;Z 5r 2 <br /> Generator Authorized Agent Name.., Signature Shipment Data <br /> Truck No. f Phone No. f f �' <br /> Transporter Name Driver Name (Print) <br /> : Address O Vehicle License No./State � <br /> E.�. ,' 1•= Y y C� • - Meh' a ""'r ification <br /> I hereby certify that the above named•material was picked-up . . ' -Ahereby certify that.the above named material was delivered wit! <br /> a# the generator site listed above, out incident.to the destination listed below. <br /> f <br /> tver.Signature ; '_.; shipment Date . river ignature ' Detivery Date <br /> DESTINATION <br /> li <br /> Site Name Phone No. �— <br /> Address <br /> I hereby certify that the above named material has-been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> .e of Authorized Agent - Sl nature . Racaipt Date <br /> PASS CODE <br /> 10166 <br /> SF1260.72C <br /> UNLOADIN <br /> .. . . . . . G- AREA �COpY <br />