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i ; Waste y No. 914858' t <br /> Sy. tenns TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> f <br /> Generator Name -% � �' rpa nsl Generating Location -�: �• <br /> Address 0 Address — <br /> T14xc tt EA a S 3*6 <br /> Phone-No. _Z a 3 5 4. 13 3 Phone_No_. I t-71 <br /> I b f 9 g Z 3 R 3 3 O Containers Type <br /> BFI Waste Code C 4. O- S D- Drum <br /> Description of Wast. Quanti Units. No.. Type <br /> C-Carton i <br /> I Z 0 1 Fil g- Bag <br /> T -Truck <br /> ❑ m ❑ P -Pounds <br /> Y-Yards <br /> Elm M. <br /> C-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 i <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 Zportatian.according t� applicable regulations. <br /> 11012- 1 =0� &4k j4_ <br /> Generator utho d Agent Name. Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. Phone No. <br /> Transporter Name Driver Name (Print) _ _ _ ___ J:�LVEKZI <br /> 4ddress Vehicle License No.IState--5l`t );gr)ZJ t <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 theflmenerator s' a listed above. ouYinc ent to the destination listed below. <br /> I signature i en Date D ever Signature- i ry ate <br /> DESTINATION <br /> i <br /> >ile Name Phone No. <br /> } <br /> +ddress <br /> hereby certify that the above named material.has been accepted and to the best.of knowledge the foregoing is true and accurate. <br /> amen `,horized Agent Signature Receibt Da <br /> PASS CODE <br /> BF1260.720 <br /> UNLOADING AREA COPY <br />