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Ts / r <br /> ' ms "'t <br /> Waste 118 6 <br /> syseWASTE MANIFEST <br /> NON-HAZARDOUS SPECIAL <br /> [1110WInNG UnRIS I11DUSTF11l rr T <br /> •r .vV d - d r �- i / e ova F b%:i :r <br /> •�. r -� I ' =. r_-r� t. >f f5�^�'w f.3�f;•�.,�r...r,r. a . .f I <br /> r , I 1 '.' ",. Generating Location__._._-....----.-.------- -- <br /> Gencrater r•L•Anle i <br /> Address. ------ - <br /> Address.__._-- <br /> . r _- <br /> {.� I ---4.1 _l.- _�_ _�!_I f .l i'liono tso L� <br /> Phline No. L-� Containers Type <br /> - — in, <br /> _' yi D <br /> f3Fl Waste Code L -.�-- I I �- Ouanlily !- I C"Cnrtolt <br /> Urscripllen 01-waste <br /> Unl1^ Na. <br /> R ©atJ <br /> -- --- - - - _�L—1 - <br /> -` T -Truck <br /> P .Potir;ds <br /> Y.yards <br /> _ l I f I� f p-Alllr�r <br /> ---_ - ����-_I L.__ S_-1___i f�n a livable <br /> a �licnble stat© law, has been properly describP,d, <br /> - I hereby certify that Ilia d u4enamewa tc as Adofinelddby ROnCI 114t'artl1ile <br /> 261 to ua y ild s pPC1kned by�0 CFE,Part een p or y <br /> state law, is not a halivable regdations. <br /> classified and packaged,and is in propor condilicn�r transportation according to app <br /> Dale <br /> GnnAlst,,orizAd A9rn1 nSmr `'+`' `nr L't <br /> �4 •�y �r r�i <br /> 3 SSA '�:ja�_ f.., il� Q j4. .7rt:9v,..r <br /> dn; lis'.i +z ? ' i. <br /> Phone No. <br /> Truck No. <br /> r� <br /> Driver Nalne(Print) <br /> Transporter Name ��:`211 <br /> v-tiicia License No.lSiate%./---.- <br /> Address <br /> vehicle Certification-1112 �` ' <br /> l hereby certify that the above named material vaas del'svered wilh- <br /> I hereby certify Ihat the above named malerial was picked up - out incident to the destination listed below. <br /> ai the generator site listed above. <br /> �� OrIfivery MOO <br /> Shiprnnrtl Dale Driver S14nalwe <br /> Ifnnr cr glgnatusa <br /> d L.-lzzSyr ,.xi i '' �� <br /> t <br /> Phone f�D. <br /> Site Name <br /> Address ------ <br /> knowledge die laregoing is true and accurate. <br /> IAereby certily that the above named material has been"Accepted and to the best o my . <br /> - - rieseinlDam a <br /> :Ilzgdzad AA ren <br /> PASS GDDE <br /> nrl211I <br /> 40lPG <br /> lr,nrl 7l tr+lr It I'IlJ'/411 <br />