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Mli!KDUS <br /> Ste No 1124391 <br /> tems r"TRIES NON-HAZARDOUS SPECIAL WASTE MANIFE% <br /> GENERATOR <br /> ` (Added L MA 49 Kfrl/v_ _ Generating Location N LACCA L S,rAT aN #G <br /> Generator Name - - g <br /> Address O BO x sl�� Address 3 7 W$ -TALf L V p' <br /> N khR1604 CA q U5 95 0 A <br /> Phone No b 3 Phone No <br /> BFI Waste Code ® 9 3 Containers TYPE <br /> Description of Waste Ouantity Units No T e D- Drur <br /> `� p o i 1 © o I Bg <br /> - cars <br /> N6 N " H lk 7-A��Lkt 501L— T -t uc <br /> ❑ m ❑ P -Pour <br /> Y -Yarc <br /> ❑ � ❑ O-Othr <br /> I hereby certify brat 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 hqLzardous waste A defined 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 /> OftIT14F w! <br /> -GerieraSignature Shipment Date <br /> TRANSPORTER <br /> -Truck No — Phone No d� <br /> Transporter Name L L o <br /> river Name (Print) v� <br /> _�Address PG W Vehicle License No/State 5jol <br /> - B f415 ) (IIA Vehicle Certification <br /> SM Rye <br /> =thereby certify that the 44ove nam d material was picked up i hereby certify that the above named material was delivered w <br /> at the enerator site ve out inside t to the desti n list below <br /> pmvr 5 natu shipment Date D wr nature Delivery Date <br /> DESTINATION <br /> Site Name 8 I 1�A'SL40 J. 1-AAI I� _ Phone No S <br /> ZL <br /> Address — <br /> 0o i Iv. V A 5CO R D. L i W <br /> - <br /> I hereby certify that the above named material has been accepted and to the best fof my 4cnbwledge the foregoing Is true and accura <br /> `Nims of AuthoKzod Agent Si nature R� <br /> ` PASS CODE <br /> F BFITip. <br />