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®ROWNING-'FERRIS <br /> Waste--w - ----_ 9Fr rc�r` �1� - 1009042 — z - JNo' 906021 --- �- <br /> Systems TM 1 - <br /> INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> E_ r';larnal <br /> generator Name Generating Location <br /> 1 G; GGA S51Q3 c�ckl � r r4 <br /> Iddress Address 5t <br />[hone No FTT� J Phone No <br /> t _ } J I� Containers TypeFl Waste Code - -- � <br /> Description of Waste Quantity Units No Type © Drum <br /> rte �teu - F= F C - Carton <br /> B - Bag <br /> �� T Truck <br /> 1 1-7-1 F� P Pounds <br /> YYards <br /> LJ -- -.1 1 1 El El 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 /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or Ry applicable state law, has been properly described, <br /> classified and packaged, and is In proper condition for transporWFpn acc rdrng to applicable regulations <br /> 3 K _ f r,H ,ar,r C - IT <br /> { <br /> neraior Authorized Agent Name Signature Shipment Date <br /> R <br /> sa� 1 �: Phone No uck No - - <br /> ans orter Name R� E� —rri,` W .J c e= (Print <br /> ) ��f �•�` �,�y 7 <br /> P - Driver Name <br /> CT M�a r c r "T-r'?f--r- ✓/�7 <br /> dress _ Vehicle License No/State _. y I <br /> B1,ersf-1 g3 308 <br /> i Vehicle Certification <br /> 'ereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> r th er�eratar sit ste j above out irlcrent to the d tina#Ion listed below <br /> I ✓ <br /> 10 EN 1 0 <br /> ver S1 nature Shipment Date DWver SiqF6turo delivery Date <br /> w <br /> h Y R D 0 <br /> �R <br /> Name Road Sari Cary Landfill Phone No <br />■' r <br /> Jd ess <br /> I <br /> i <br />�reby certify that the above named mater:al has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> PA:uthorized A enl Si nature Receipt Date <br /> PASS COBE <br /> SF1260 720 <br /> GE'N'ERATOR rrRISET NN' <br />