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!J 11Vaw7l�.rr' No. 91`t.8b V r <br /> Systems TM _ <br /> IROWNING-FERRIS INDUSTRIES . :,NON HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> aen'dName f)�.+ , Ir9or\'AI�- (+"­P .ly Generating Location _ ^ <br /> e <br /> ,ddres5 �ISa �..s�- Grp �� ke Q� _. _ Address 9 <br /> CA R 3 6 <br /> hone Na. S, 9 S 3 3 Phone No.. <br /> Fi Waste Code G y o 5 i o l R R 2 3 3 3 0 Containers Type <br /> Description of Waste Quantity Units No. Type 'Drum <br /> l C-Carton <br /> S e; w �zoSC' ! g [E] 0 � T B- Bag <br /> T -Truck a <br /> E m ElP - 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 CFA Part 260.10 or any applicable <br /> state taw, is not a hazardous waste asdefined 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 /> r <br /> sa t U /�` 217 `I' <br /> nerator Altithorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Phone No, <br /> insporter Na IAn k4, :Zicle <br /> er.Name (Print) <br /> dress License No./State <br /> Vehicle Certification <br /> :reby certify that the2b/.e named material was picked up 1 hereby certify that the above named material was delivered with- i <br /> tl� ge erator site listed ove. out incident to the destination listed below. <br /> 1116212- 1-7 <br /> U Z <br /> re '.Shipment Da nature Delivery Date <br /> • i <br /> DESTINATION <br /> Name Phone No. �— <br /> I <br /> Iress <br /> !reby certify that the above named material:has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> !of A�ulhorrized Agent <br /> " <br /> Signature Aec ipt Da <br /> Y <br /> 4 PASS CODE <br /> BF1260.720 <br /> UNLOADING AREA COPY <br />