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s <br /> !� Waste No 1026688 <br /> Systems `" NON-HAZARD E MA ES- <br /> BROWNING-FERRIS INDUSTRIES OUS SPECIAL WAST NIF <br /> GENERATOR <br /> Generator Name-! -o � ���aY �•••4 Generating LocationU•-mos-­+\ <br /> Address d S Address 1 `� <br /> Phone No, 5 — a 1 '1 3 3 Phone No <br /> BFI Waste Code \ O °"� � (� �\ \ (� '� Containers Type <br /> Description of Waste Guanttt Units No T e D-Drur <br /> C-Cart, <br /> 0 w ��►�Z�'C O y...S S p O jo 0 t � © ® B -Bag <br /> T -Truc <br /> Elma P .Pour <br /> Y-Yarc <br /> Elm ❑ O.OthE <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicabi <br /> State law, is not a hazardous waste tis defined by 40 CFR Part 261 or any applicable state law, has been properly describe( <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> EiEEI <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> I Truck No, �p t.'��i– <br /> Phone Na SLCLso <br /> e Transporter Name.\��r�. `y."�.y�a � Driver Name {Print) 8'62n�AAZV <br /> i <br /> ' Address _S". ant �-�� _. Vehicle License No/State Ake w -- 6117 7 A.S 7K <br /> i .� <br /> • - ._ �:'��it Vehicle Certification 3�4 ��•2 �3�, <br /> _I hereby certify that tha above named material was picked up I hereby certify that the above named material was delivered v <br /> at the generator site listed above, out incident to th tination listed below <br /> 0 dr 4 <br /> EDriver Signature T`• Shipment Date Driver Signature Delivery Date <br /> I <br /> _ - <br /> DESTINATION• <br /> Site Name. _.� . . Uva tt� a. t..h•.b,�.��_ Phone No S \ V — u► 1 O LA 9 <br /> ,,4ddress.. <br /> �e. 1 hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accur. <br /> . 12 <br /> Name of Authorized Agent Signature I Vi Receipt Date <br /> PASS CODE <br /> 1 Q/88 - -� aF12f <br /> TRANSPORTER RETAIN <br />