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r <br /> No- <br /> (.Y 543683 <br /> NON-HAZARDOUS SPECIAL WASTE <br /> TR'�5 , MANIFEST <br /> • <br /> 1 N11 <br /> Genera Name Q� C h <br /> DQE Generating Locatio <br /> Address 'v' �� ��� j <br /> Address <br /> Phone No. <br /> Phone No � 1 <br /> BFI Waste Code <br /> KEE ` Containers Type <br /> Description of W ste <br /> [� QuantityUnits �No� T e D-Drum <br /> � C-Carton , <br /> B -Ba <br /> T -Truck <br /> ❑ ❑ P-Pounds <br /> Y-Yards <br /> ❑ E ❑ O-Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260110 or any applicable } <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper n ition for;transp rtation according to applicable regulations. <br /> Generator Authorized Agent Name Signature <br /> Shipment Date .I <br /> �TRANSPORTER <br /> Truck No. 3I� Phone No. <br /> Transpo rName Driver Name (Print) <br /> � 5� <br /> � Q \ Q 4 <br /> ) O <br /> Address \ Vehicle License No./State-3 <br /> _ <br /> \�\� " Vehic a Certification 30 0 <br /> .1 hereby certify that the above named material was picked up here erti above named material was delivered with- <br /> a, th nerai�iist;ed above. ut inti to the destination low.l <br /> 3 3 / <br /> Driver Signature Shipment Date Driver Signature Delivery Date <br /> r l <br /> DESTINATION <br /> Site Name "G � "\ Phone No. <br /> Address <br /> I hereby certify that the above named material has been accepted and to the bestfof_,no edge the foregoing is true and accurate. 1 <br /> 1 <br /> Name of Authorized Agent <br /> Signature // Receipt Dale <br /> PASS CODE <br /> 10188 <br /> SFt2M720 <br /> UNLOADING AREA COPY <br />