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WEITSW <br /> '3 <br /> p <br /> oSysteins ­rm NOS 5'� 3 O 6 `7 I <br /> J_, BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br />} <br /> i. GeneralVNa�m R��\� \� �% k <br /> Generating Locatio \ \� <br /> AddressAddressAINq \ <br /> Phone No. AP <br /> hone No.KOK]— <br />! BFI Waste Code �l , Containers Type <br /> Description of Waste Quantity Units '' INo. Type D-Drum <br /> (�L\ W FT <br /> C Carton <br /> �� B -Bag <br /> T -Truck <br /> P - Pounds <br /> m <br /> Y-Yards <br /> �- ❑ m ❑ O-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 <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 nd ackaged, and is in prop ndition f trans ortation according to applicable regulations. t <br /> l <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> + <br /> Truck No. _ 1 (0Phone No. <br /> er me � Driver Name (Print)Transportr ll 01 n <br /> D- o� , P <br /> Address Vehicle License No./State �` 3 4"�p L-/ <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 t estination listed below. <br /> Driver Signature ShipmentDate Driver Signature Delivery Date <br /> ' } it t <br /> DESTINATION <br /> Site Name����� Phone No. ®— . <br /> F r, p� on <br /> Address V \ �� <br /> I hereby certify that the above named material has been accepted and to the best of owled a the 4oregoIng is true and accurate. <br /> Name of Authorized Agent Signature i Receipt Date <br /> i <br /> i, PASS CODE <br /> 10186 BF1260-720 <br /> UNLOADING AREA COPY <br />