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Waste 1064750 <br /> No 64750 <br /> gR I Systems r <br /> NI _ <br /> FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> aerator Name - <br /> CIC/ "T. <br /> �J Generating Location <br /> dress <br /> � Address <br /> I _ <br /> Phone No U <br /> Phone No <br /> Waste Code l - E]�D= <br /> of Waste Container T <br /> Descn t,an <br /> S ype <br /> Ouantit Units No T e D - Drum <br /> B - Bag <br /> El W 1:1T - Truck <br /> P - Pounds <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 /> EL=state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classiffiied and packaged, and is in proper condition for transportation according to applicable regulations <br /> ra{Dr Authorized Agent Name zognavure / <br /> Shipment Date <br /> now <br /> ruck No Phone No <br /> Isporter Name C'f S� '� - �C �[� <br /> _ Driver Name (Print) <br /> ddress Vehicle License No Slate <br /> Vehicle Certification <br /> reby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> e erator site listed abov ou cident to the destination listed below <br /> Signature Shipment Date river Signa re Delivery <br /> Name � <br /> Phone No F7 M— <br /> OSS r 5S <br /> iereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> 21 <br /> Of Authorized A eat SI gnature RBCei t Date <br /> PASS CODE <br /> OF1260-720 W9 <br />