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01cSte No. <br /> systeM.&TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFES- <br /> GENERATOR <br /> Generator Name (j r!�»,;.;'� Generating Location <br /> Address _ _Address SAM <br /> 1 <br /> ,TRACE,. CA :.95376 SAME <br /> Phone No? .2 r p r ��' '6� ;3 '5'-.gig ` ]; 3 ..3 • ;�. p g 8 3.• ':J: 1, 3 3: <br /> one No. <br /> `BFI Waste Code' C y D 5 D R Z"p, 6. 3 3 b Containers Type <br /> Description of Waste Quantit Units No. T e D-Druf- <br /> ` <br /> o l - C Carl <br /> © B - Bag <br />' m T -Truc. <br /> P -Pour. <br /> Y-Yarc <br /> O=Othe <br /> I.hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicabl <br /> state law, is not a hazardous.waste as..defined by 40.CFR Part 261 or any applicable state law, has been properly describes <br /> classified and packaged, and is in proper coed' " n for nsportation according to applicable regulations. <br /> Generator Authorized Agent Name• Signature ',Shipment Date <br /> TRANSPORTER <br /> Truck No. _ r1 Phone No. <br /> Transporter NameS �✓• Driver Name (Print) ' <br /> Address Vehicle License NodStateele' >`1 d ee 9 <br /> Vehicle Certification <br /> 1 hereby certify that the above named material was picked up,_: 1 hereby certify thatthe'above named material was delivered u <br /> at the generator site listed above.. ;;., out incident to the destination listed below. <br /> i e Shipment Date . .Dever Sl tura Delivery Date <br /> rSg. l P g <br /> DESTINATION <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 accurz <br /> U. `-` <br /> jame of Authorized Ag enl SI nature Receipt Dale <br /> PASS CODE <br /> iu8t3. s -... . .. SF1260 <br /> 1 . <br /> 4. <br /> r . UN.LOJ;O NG AREA COPY <br />