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` . <br /> '_ . <br /> �� <br /> ��NU ���������������� <br /> LE ^~�' _ _ <br /> RVA k936, eBN|Cm.CA9ws1n.(rnr)747-6699 <br /> ~— <br /> NON-HAZARDOUS��X U� ����A�� � y� ���U���� <br /> x�"~�o��o n���~������v~v���� ��o �~��n��u~ WASTE MANIFEST <br /> GENERATOR <br /> Generator Name Generating Location <br /> Address C4 0 0 aooname <br /> Phone No. -- Phone No. <br /> Containers Type <br /> Description of Waste Quantty Units No. <br /> |�� �� <br /> | | | <br /> �� ���� �� <br /> P - Pounds <br /> �� �� <br /> � | | | <br /> �� �� <br /> | hereby certify that the above named material does not contain fmoo liquid as defined by 40 CFR Pan 280.10 orany applicable <br /> otoko |mvv' is not u hazardous waste as defined by 40 CFR Part 261 or any applicable state |ovv, has been properly doxohbed, <br /> o\oxoiUed and pankugnd, and is in proper condition for transportation according to applicable regulations. <br /> Generator Authorized Agent Name Signat&4 Shipment Oale <br /> TRANSPORTER <br /> Truck No. /-� Phone No. <br /> Transporter Name Driver Name (Print) <br /> ' <br /> Address \�;2 C(. � I� V*hiu|o License No./State <br /> ~ ' <br /> Vehicle Certification <br /> | hereby certify that the above named material was picked up | hereby oort|h/ that the above named material was delivered with- <br /> at the <br /> |th'at1he generator site listed above. out incident to the destination listed below. <br /> e. <br /> 171 <br /> [)river Signature Shipment Date Driver Signature Deliv"Date <br /> DESTINATION <br /> ~ <br /> Site Name " Phone No. -- <br />