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1 Waste No. 914854 <br /> SY.§te`Ms TM <br /> BROWNING-FERRISINDliS7AlES NO{.V-HAZARDOUS SPECIAL. �. <br /> WASTE MANIFE <br /> GENERATORjr <br /> Generator Name l "' "� �� t�,t', .'z ___ Generating Location <br /> Address Address -S-k Q ' <br /> Phone No. z 0 — $ 3 S i 13-F] Phone No. <br /> C 11 3 q 3 p Containers TYPL i <br /> 3171 Waste Code D- Dru. <br /> {{ <br /> Description of Waste' Quantity Units. No. T Pe C-Car: <br /> B - Bac <br /> T -Trui <br /> m El P -low <br /> _. Y -Yar <br /> m ❑ a-otr. <br /> I hereby certify that the-above named material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicat <br /> state law, is not.a:hazardous waste-as defined by 40 CFR Part 261 or any applicable state law, has been properly describe <br /> classified and packaged, and is in proper condition for tr sportation according to applicable regulations. <br /> I J= <br /> ienerator 4uLdorized Agent Name. :':-Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. fi' Phone No. err `r <br /> Transporter Name 1�91, 1 u .Driver Name (Print)i. - 0 <br /> ' Address Vehicle License No./State 14Z,23 2 <br /> Vehicle Certification <br /> I hereby certify"that the above named material was picked up- 1 hereby certify thatthe above named material was delivered <br /> at the generator site listed above. out incident to the destination listed below <br /> Driver Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name Phone No. <br /> Address <br /> hereby certify that the above named material has been accepted and to the best of k wledge the forggoing is true and accui <br /> Name of Authorized Agent signature Receipt Dale <br /> PASS CODE <br /> • `..r SF12C <br /> 10186 <br /> I IRtI r1 AMIhIn- Ar]rr;1 r•nn.i <br />