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43684 <br /> V. STRIES - <br /> rr;rtRlS INDUSTRIES NON HAZARD <br /> O <br /> US <br /> SPECIAL AL WASTE MANIFEST <br /> GENERATOR <br /> Generato Name Generating Location <br /> i <br /> . " Address <br /> Address <br /> I <br /> Phone No. KEN— — <br /> Phone Na. 'C <br /> BFI Waste Codemix .Containers Type <br /> Descriptionof Waste Ouantity Units No. T e D-Drum <br /> Carton <br /> ❑ m ❑ T -Truck <br /> P-Pounds <br /> Y-Yards <br /> O-Other <br /> El 1:1 <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 26'0.10 or any applicable <br /> f. 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 pr er condition.for transportati n according to applicable regulations. <br /> Generator Authorized Agent Name <br /> 9 Signature i Shipment Date j <br /> TRANSPORTER <br /> Truck No. _ <br /> # Phone No. <br /> a <br /> Transport Name �w <br /> p v `! = Driver Name (Print)� Q�fL_�`�—Q t•�_ <br /> Address �' Vehicle License No./State L L I <br /> ` @ @ <br /> � Vehicle Certification <br /> 1 jeretertify that the above named material was picked up I hereby certify t t the Bove named material was delivered with- <br /> ator site listed above. out i ci nt to e e Nation liste <br /> rive gnature Shipment DateD er Si Aature Delivery Date <br /> 1. <br /> DESTINATION <br /> �. ��Site Name �� ` v �\`phone No. �--- <br /> Address ��� S� <br /> I hereby certify that the above named material has been accepted and to the best of-my knowledge the foregoiing is true and accurate. <br /> Name of Authorized Agent Signature R& t Date <br /> 1 <br /> 4 <br /> PASS CODE <br /> 10/86 BR260.720 <br /> 1 <br /> UNLOADING AREA COPY ' <br />