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r .:.6al <br /> ]/Se111S �" N° 9'15 9 4 2 <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATORI <br /> Crator Name i.. r ` <br /> Generating Location <br /> Address 450 E. GRANTj, R= Address SAME <br /> i 'LACY, CA 95376 <br /> SAME <br /> Phone No. ' 0. '9. 8` 3 5 -9. 13 3 r <br /> Phone No.' <br /> Lt .r I <br /> BF1 Waste Code © 1 D I O 1 9 Z 3 3 3 b Containers Type <br /> Description of Waste Quantit Units No. T pe D-Drum <br /> C-Carton � <br /> B- Bag <br /> m T -Truck <br /> P - Pounds <br /> � <br /> Y-Yards <br /> 0-Other _ <br /> m <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 not a hazardous waste -as defined by 40 CFR Part 261 or any applicat4e state law, has been properly described, <br /> classified and packaged, and is in proper con ' ' n for nsportation according to applicable regulations. <br /> BOB FAG[T E S, PLANT MANAGER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Tru4ii No. Phone No. <br /> Transporter Name Driver Name (Print) <br /> Address -`t1 Vehicle License No./State <br /> Vehicle Certification <br /> i <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 gener for site listed abo e. out incident tg-t a desti atio listed below. <br /> v 2 G 2 ,rr`} v 6 Q. <br /> gtIV ignalure Shipment Dale DriverSy'ghatur r ( u 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 of my knowledge the foregoing is true and accurate. <br /> Name of Authorized Agent <br /> Signature , Receipt pate <br /> • <br /> PASS CODE ` <br /> 40/86 . BF1260-720 <br /> UNLOADING _AREA. <br />