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ti <br /> Waste No. 916 0 4.7 r <br /> SS 'mS TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> , <br /> GENERATOR <br /> Generator NameGenerating Location <br /> Address- 450 E. GENE= BMD Address Sam <br /> . .c..—a. Y '. �' Twp• �,. - _ • C; }f -, ' - - , <br /> (�Fwne No " a <br /> Phone N •' , <br /> BFI Waste Coder `f v L, o I 21 111"1- 11 -3 o Containers Type.. <br /> Description of Waste ©uantit Units No. Type o- Drum <br /> y{ tt O , C-Carton <br /> �n1] uj dioSO � B - Bag <br /> T -Truck <br /> 17-1 F7 m ❑ P - Pounds <br /> Y-Yards <br /> ❑ m ❑ 0-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 for nsportatiion according to applicable regulations. <br /> BOB F8GLVMS,PLVE MAMNOM rJJ fit)(, I I o Z 4 Z <br /> 3enerator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> -- Phone No. �•���'� f <br /> Truck No. � <br /> rransporter Name Driver Name (Print) <br /> 4ddress _ lr---14�2 Vehicle license No./State <br /> :Vehicle Certification <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> it the-generator site listed abov out incident to the destination liste below. <br /> 12 r)4 <br /> 1 0 7 <br /> }aver Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> h <br /> 3ile Name Phone No. �— <br /> address_ <br /> hereby certify that the above named material has been accepted and,to the bes riowiedge the foregoing is true and accurate. <br /> v <br /> Jame thorized Agent Signature eceffoi DaTe <br /> PASS CODE <br /> 0186 BF1260.720 I <br /> UNLOADING AREA COPY <br />