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WasteNo: g 16038 <br /> S]/Ste171S rpt <br /> -HAZARDOUS SPECIAL WASTE MANIFEST <br /> BROWNING-FERRIS INDUSTRIES NON �` "'�' ` <br /> GENERATOR <br /> J_ 1idL: .I'JaJIJtJCIJ CCi°L'1"•� 1 ;:•yJ':i' <br /> Generator Name Generating Location <br /> Address 450 E. GRANT= SAD Address SAME <br /> i.. TRAIGY,..(� 95376 <br /> Phone No. <br /> .3' .5 9 1" 3 3 Plione No'. <br /> ContainersType <br /> BFt Waste Code b 5 D 3 3 t5 7rs e D-Drum <br /> rr ii <br /> Description of Waste QuantityUnits NoC-Carton <br /> Sort w �I'Set 1g a { <br /> E3.-Bag <br /> S -Truck <br /> . ❑ m ❑ <br /> P"-Pounds <br /> Y -Yards <br /> E m 1:1O-Other <br /> I hereby certify that the above named material does not.contain free liquid as defined by 40 CFR Fart 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-co 'tion fo ransportation according to applicable regulations. <br /> BOB FAGIM=r PIANF MAM { Z <br /> r-'enerator Authorized Agent Name Signature Shipment Date <br /> Truck No. Phone No. <br /> i 0 ' G <br /> . Transporter.Name Driver Name (Print) — �� <br /> Address 'Z 7117 <br /> Vehicle License No./State �� Z <br /> Vehicle Certification <br /> I hereby certify that the above nate d.material was picked up-;=', I hereby certify that the above named.material was delivered wi' <br /> at the en rator s' listed above. out i ident to the destination listed below. <br /> Wo lk-d� <br /> Driver Signature hi mens Date. <br /> Driver Signature Delivery Date <br /> DESTINATION <br /> Phone No. <br /> Site Name <br /> Address <br /> I.hereby.certify,that.the above:named material has.been accepted and to the best of my knowledge the foregoing is trot: and accurat <br /> Receipt Date <br /> '0 Name of Authorized Agent <br /> Sign a <br /> i nature <br /> PASS GODS <br /> 10188 <br /> UNLOADING,:;AREA COPY <br />