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t' <br /> :. .. 9 .4857 r <br /> - ste <br /> casy'stems"M" NON-HAZARDOUS SPECIAL WASTEMANIFEST <br /> BROWNING-FERRIS INDUSTRIES <br /> • <br /> WMIM <br /> j <br /> Generator Name Generating Location { <br /> � " F�'� """, <br /> - Address <br /> Address _ N S 4 F�Sk aw �a — <br /> Z o q - Q 3 5. ! 3 3 Phone No. <br /> Phone No. Containers Type <br /> BF(Waste Code'EQ]Q q S I k Z 3 D-Drum <br /> Descri tion of Waste Quantit Units No. T e C_Carton <br /> EE= 0 B - Bag ! <br /> ✓ �IIQSe\ T -Truck <br /> Y El EE ❑ I -Pounds <br /> Y-Yards <br /> y ❑ m ❑ O-Other . <br /> cable <br /> I hereby certify that the above.named:material does not contain.fres liquid as del`cable statened by 40 Caw, has. been properly desFR Part 260.10 or any cribed, <br /> state law, is nota hazardous waste-as defined by 40 CFRPart261 or any p e e regulations.as. <br /> classified and packaged, and is in proper condition for tr ns ortaiion accordingto app' <br /> : Shipment Date <br /> 7. ...signature <br /> Generator A orized Agent Name <br /> • <br /> Phone Na. <br /> Truck No. V <br /> ~' Driver Name (Print) <br /> ' Transporter Name <br /> Vehicle License No./State <br /> Address <br /> Vehicle Certification ` <br /> hereby certify that the above named materiai.was picked up I hereby certify that the above named material was delivered wit <br /> at the generator site listed ab ve. out incident to the destination listed below. , <br /> y� /... r <br /> Delivery Dale <br /> Shipment Date Driver Signature <br /> Drivel Signature <br /> 'i <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 aowledge the foregoing is true and accura i <br /> ecei 1 Date it <br /> .. <br /> madame of Authorized ant <br /> - i <br /> PASS CODE <br /> BF12& <br /> 10156. <br /> .Wit.•3�; '" .,r <br /> '^ = UNLOADING AREA COPY. . <br />