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A � _ <br /> W <br /> Waste <br /> r , p NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> � <br /> a iII54Li0y 9 i4o' TI,7 NO 1 <br /> � <br /> ;r4 r'4 <br /> r��r�r <br /> 0T117V17t1[JG FErirtl5 117PU57RIES r77 <br /> "'P""`�'°'T�`�• L, ..r <br /> - <br /> 1 77 7 ` y <br /> i <br /> Grneratirsg Location <br /> Generator Name __-_� - -- i;I } l +t l• t ' -._..__----- <br /> t L Address - --- ---' --- --- <br /> __ <br /> Address .__-_-----�'-----`—__—. <br /> ll [4 ` <br /> -- 4 1 r l T.- D 1 I _.j Phone No. _ -- <br /> C[ C� _ I_- Containers TYl1e <br /> Phone No. S_ <br /> �_ 1 Units Typ?e ,r n <br /> No. <br /> C•G1ta <br /> EiFI wastu code _ . <br /> El <br /> Dcscrilriitm of wash -- p-Bag <br /> -- -- - - -... T .Truck <br /> r ` 4 1 P•Pounds <br /> O other <br /> ahT licable <br /> 40 CFR Pail 260.10 or any.,p <br /> -40 CF11 part 2Gt or any applicable stale faw, has beer, properly dascrihed, <br /> I liereby cerlily that the above named material does not contain Jreo liquid as de7inedlicabla regulations. <br /> slate lar+• is not a hazardous waste as defined by <br /> classified and packaged,and is in proper condition for transportation according to app <br /> ` 'Shipmentzz <br /> Uale <br /> Genor',lor Acihcri.cd Aga,1 IJzine _11471M tsx-"+'�` 'r-"'•,3.•ra <br /> -i r - f.�.:L..�.-t:�c'-•v.Yn�""""W` r..�•'�.isxeiYti...:ui:S /t I'_ r t _ .. <br /> Phone No. <br /> � l ' ' <br /> Truck No._ -- - llr.-�� '1!/.� <br /> 7 t t`:• Driver Name(Print} <br /> Transporter Name <br /> l: Vehicle License No.IState � <br /> Address <br /> J ; s r ''•r' L- ' �_ Vehicle Codification y " <br /> I hereby certify <br /> ltte kilo anion listed below. <br /> rial was delivered with <br /> I hereby certify that the above named material was picked up out incident <br /> a1 the generator site listed above. <br /> Date <br /> SliipS <br /> n,cuQala <br /> Qiivcr Signtlur© inn �' �g tM rr g' ..A^3' Lr ., TO <br /> 4• ' - ''I q�}S A41 •...• jL a 0 i'f•; '4�r.+`+c4' ;+ft Y •. Y'',�- �_� t <br /> .,moi LL �1Pl�s 4er;a»�7j t•�`r�rr''?. t{. <br /> Phone No. <br /> Site Name ---• -_� •{ .r r -..•—.•�--- <br /> Address. ___ - — -�--- <br /> true and accur <br /> r <br /> 1 hereby certify!Isar Use above Warned material has been accepted_and_la the_best of r+ knowledge the foregamsi_-A' <br /> y C <br /> skranawre�----�._ _�--------- —..— <br /> aor,fullfonred Mani - <br /> PASS GORE gR2r,0-720 <br /> l"Vi <br /> r I,�;S I•',r•r,:,t rt�tl I?l'1111P1 <br />