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'mWaste <br /> ' o914^`8 51 <br /> Sy§te 'ms TM i <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name y%s• LA Generating Location <br /> Address S G Address <br /> Phone No. —Is-Is S f 3 Phone No. �— <br /> BFI Waste Code Ho Is- t 0 1 R Z 1111 3`, 3 U Containers Type. <br /> Description of Waste Quantity Units No. Type D- Drum <br /> SS t C-Carton <br /> B-Bag <br /> m T -Truck <br /> ElP - 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 not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, F <br /> classified and packaged, and is in proper condition fort nsportation according to applicable regulations. <br /> Generator Aulthorized Agent Name signature ' Shipment Date <br /> TRANSPORTER <br /> Truck No. Phone No. <br /> Transpar#er Nam r C river Name Print <br /> t ) <br /> Address cle License Na./State � Y <br /> i <br /> Of <br /> Vehicle-Certification <br /> I hereby certify that t e above named material was picked up 1 hereby certify that the above named material was delivered with, <br /> at generator site listed above out i 'dent to the destinat' isted below. <br /> ver ig azure Shipment Dae r ur 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 knowledge the foregoing is true and accurate. <br /> I �of Authorized Agent Signature Rece i Dale <br /> PAS&CODE <br /> 10186 • BFI260.72c <br /> . i <br /> i <br /> UNLOADING AREA COPY <br />