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s <br /> No.'. 'g.16 0.4.0 <br /> Systems TM t <br /> BROWNING-FERRIS INDUSTRIES' NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> r <br /> GENERATOR <br /> Generator Name 1Jk''u'1. `::.:..r.•.:�,J':, ' <br /> Generating Location- w <br /> .. r 450 E. � RQF�D SAME <br /> Address Address <br /> Chi 95376 . SAME <br /> a r R i <br /> ;'hne No - •-Phone No. �b � ' . - <br /> har ~r <br /> BFI Waste Code C �` y C) a Z 3 3 3 Containers Type <br /> D- Drum <br /> Fr <br /> Description of Waste Quantity Units No. T pe <br /> C-Carton <br /> $c�C` w c�1QSe� 2; `J t B-Sag l <br /> T -Truck <br /> ❑ m <br /> P - Pounds <br /> Y-Yards f <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 nota.hazardous waste-as defined.by 40 CFR Part 261 or any.applicablestate law, has been properly described, <br /> classified and packaged, and is in proper.condi - n for t sportation according to applicable regulations. <br /> Z <br /> EM FACIRMS, P= M <br /> Generator Authorized Agent Name ignature: Shipment Dale <br /> TRANSPORTER— <br /> Truck No. Phone No. <br /> Transporter Name Driver Name (Print) ��'P <br /> Address hicle License No../State 4::-- <br /> AM <br /> C Vehicle Certificatiop- <br /> f <br /> I hereby certify that the abov named material was picked up. I hereby certify tgatAhe,6ibo a material was delivered with- <br /> at t enerator site.lis above. out i ent to thelldesti atioli below.. <br /> � s <br /> Z17 X77 <br /> e i nature Shipment Date Dnv r Si atura Delivery Date } <br /> DESTINATION <br /> Site Name Phone No. I <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 /> w9" * 'Signature / Receipt Dale <br /> Authorized Agent , <br /> PASS CODE <br /> ` BR260720 <br /> 110166 . . <br /> UNLOADING AREA COPY "� � " <br />