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r <br /> OSystems ;M <br /> Wa-stef> „ c No. X436 <br /> BROWNING-FERRIS INDUSTRIES NONHAZARDOUS SPECIAL WASTE MANIFEST <br /> f <br /> GENERATOR <br /> V <br /> f{ Generat Nam \��� V J <br /> Generating Location <br /> • ��.Address <br /> Address ��� <br /> h I <br /> ' Phone No <br /> Phone No.�� I <br /> BFI Waste Code Containers Type <br /> Description of Waste , Quanti Units No. Type K�j� <br /> D-Drum <br /> �y C-Carton <br /> \ _ © Sag I <br /> T -Truck <br /> \ ❑ ❑ P -Pounds <br /> 4 <br /> Y-Yards <br />'� � ❑ � ❑ O-Other <br /> i <br /> I hereby certify that the above named material does mot 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 269 or any applicable state law, has been properly described, <br /> classified an acged, and is in proper ition for tra.spo ion acco in to applicable regulations. <br /> 11k 1 11 <br /> 1. i <br /> Generato Authorized Agent Name Signature Shipment Date' <br /> A <br /> TRANSPORTER <br /> Truck No. Phone No.�` � <br /> Transporter me Driver Name (Print) 0S7�c2_ <br /> L} <br /> Address Vehicle License No./State / Z F <br /> Vehicle Certification <br /> hereby certFfy that the above named material was picked up I hereby certify that he above named material was delivered with- <br /> al the ge,{lera listed a ue� out inti ent to destinatio -below. <br /> r , TETI t 7 <br /> Driver Signa[ a Shipment Date Driver Signature Delivery pate <br /> DES <br /> TINATION <br /> Site Name �, Phone No.�— j� nb SR N I <br /> Address � �1 <br /> s <br /> 1 hereby certify that the above named material has been accepted and to the best of my knsedge the foregoing is true and accurate. <br /> Name of Authorized Agent Si nature Receipt Date <br />. PASS CODE <br /> 1D18fi 11 <br /> BF12fi0-720 <br /> UNLOADING AREA COPY <br />