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eWastei �' t <br /> n .. : 11543686 <br /> � ;je �y No <br /> �� <br /> TM <br /> BROWNING-FERRIS INDUSTRIES <br /> ! i !s NON-HAZARDOUS <br /> SPECIAL WASTE MANIFEST <br /> I: Genera r Nam <br /> Generating Location <br /> Address \ Address <br /> 1� 1 � i <br /> Phone No. � i <br /> Phone No. r�i <br /> BFI.-Waste Code \ <br /> 1 Containers Type <br /> bescri tion ofWaste Quan#it Units No. T pe D-Drum <br /> � I � I t I C-Carton i <br /> `y\ LTJ B -Bag <br /> T -Truck <br /> P - Pounds <br /> Y-Yards <br /> � T <br />' Elm ❑ O Other <br /> I. <br /> 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, <br /> classified and ckaged, and is in proper dition for trns ort ion accordi ,-oapplicable regulations. <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Truck No. � � _ Phone No. <br /> Transport me `�� a \�- ' Driver Name (Print) <br /> _24, <br /> r' l <br /> Address �� \ Vehicle License No./State <br /> \�L�- v \ \ Vehicle Certification <br /> I hereby cer9fy that the above-named material was picked up I hereby certify that the above named material was delivered with- <br /> at the generate.site listed)abave. h / out incident tote destination listed below. <br /> Driver Signature G' shipment Dat Driver Signature , ij Delivery Date <br /> DESTINATION <br /> Site NameX ` ` �`\\ ` ti'�I „ 1\i\\ Phone No. �-- <br /> Address`' \ <br /> I hereby certify that the above named material has been accepted and to the best of k wledge the foregoling is true and accurate. <br /> Name of Authorized Agent Signature 1 Recent Date <br /> PASS CODE <br /> 10/86 BF1260.720 <br /> UNLOADING AREA COPY <br />