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Waste No. 914853 <br /> SysterriS TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name 0 Q IL e� Generating Location <br /> Address H 5Z0 c �* ��� t"�' � ` Address SQ"^ <br />'' Yro.cv CIS AC -A76 _ <br /> Phone No.' Z O 9 —1211 IS- 1 M3 Phone'No. <br /> 0 Z 3 93 . a Containers Type <br /> BFI Waste Code D- Drum <br /> Description of Waste Quanti Units No. �-711- <br /> {{ FT C-Carton <br /> soil W j 1105e� 1 F1 Z � B -Bag <br /> T -Truck <br /> El <br /> m 1:1 <br /> P -Pounds <br /> Y -Yards <br /> LL <br /> ❑ m 11O 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 1 <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 transportation according to applicable regulations. <br /> nn �� ��� la.JD'�'" i n 2 � Z • <br /> Generator Autbbrized Agenf Name Q Signature Shipment Dale <br /> Truck Np'� ' Phone No. <br /> Transporter Name Jen>S (Sc,4-'C rrr z__ Driver Name (Print) <br /> Address U Vehicle License No./State <br /> Vehicle Certification <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 generator site listed above. out incident to the destination listed below. <br /> 7 <br /> :o1r,tignature Shipment Date r' r Signa re Delivery Pate <br /> DESTINATION <br /> Site Name Phone No. <br /> s <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my dge the foregoing is true and accurate. <br /> —� Recei Dat <br /> N i Authorized Agent Si nature <br /> 4 <br /> PASS CODE <br /> BF1260.720 l <br /> 10!86 <br /> UNLOADING AREA COPY ! <br />