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Systems TM <br /> W6�te <br /> No g.16�.4 5 <br /> BROWNING-FERRIS-INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name Generating Location 2A Dim, <br /> Address 450 E. GRAN'Y`LIl31v )SAD Address SAS k <br /> TMLY.' CASME <br /> 9X376 <br /> ,I'hor�e iVa 2 0 fir - $ n. <br /> r r 3 `� 3 3 Containers ..._:. <br /> $FI Waste Code 5 i' `� q Z ers TYpe <br /> Descri tion of Waste Quantity Units No. Type D-Drum <br /> © U ( B-Carton <br /> [[[ Ilk 111 B-Bag � <br /> m T-Truck <br /> • ❑ P -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-nota 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 condition gfsportation according to applicable regulations. <br /> BM FAG[ , PLANT Nit <br /> Generator Authorized Agent Name Si nature t a Z <br /> g Shipment Date <br /> • <br /> Truck No. [ �` U Phone No. <br /> Transporter Name. s Driver Name (Print) v � <br /> Address Vehicle License.No.IState. �r <br /> I Vehicle Certification <br /> I hereby certify that.the above named material was picked up I hereby certify that the above named material was delivered with- <br /> at•the generator site listed above. out incident to the destination fisted below. <br /> A .L <br /> • G.. G d 4 <br /> Driverig tureIi.: Shipment Data rry Slgn tura Delivery.Date <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 o owledge the foregoing is true and accurate. <br /> at Authorized Agent S nature Receipt Date <br /> PASS CODE <br /> 1W86 <br /> ... 12 <br /> . .. .. -.. . .. _. 6D-720 <br /> UNL6,.4bftqd"AR' <br /> EA COPY <br />