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; VY�e � � � � <br /> Systems TM No. 51 6, 2 <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> GenQr Name F711i`gL` .rT,r.LAX:l—, r�Y f;z��tii.^,r Generating Location �'• ,s• <br /> Address 450 Address <br /> SAME <br /> k <br />,Phone No. Phone No. �— <br /> BFI Waste Code C A ' b 5 1 y 9 Z 3 �( 3 3 b Containers Type <br /> 4 Descri tion of Waste Quantity Units No. T e D- Drum <br /> Sor� �( c�roSQ1 1 � LLQ O j C-Carton <br /> w B'-Sag <br /> T -Truck <br /> m� P -Pounds <br /> Y -Yards <br /> Elm ❑ 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 not a 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 <br /> /f ransportation according-jo applicable.fegulations. <br /> BOB FAGM=, PLAN , ` (,f <br /> 3enerator Authorized Agent Name Signature' Shipment Date <br /> TRANSPORTER <br /> i ruck No:----=` Phone No. <br /> transporter Name Driver Name (Print) hr <br /> i <br /> Iddres5 ^ �f�L <br /> 4�&7�J a7J .Vehicle License No./State <br /> Vehicle Certification <br /> hereby c th th bove named material was picked up i hereby.certif that the ab ve named material was delivered with- <br /> t the n to ite ed above. out incide the s ion listed below. <br /> r' r Signature Shipment Dale DIV {Signature Delivery Date f <br /> DESTINATION <br /> ite Name Phone No. <br /> l <br /> ddress <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> Lme of F�•ihorized A ent Si nature R9CeiDt Date <br /> i <br /> PASS CODE <br /> ' BF1260.720 <br /> UNLOADING AREA CQPY <br />