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tiU.��,j t,l.�•,i. !. <br /> Waage <br /> systems "' <br /> NON-FIAZARDOUS SPECIAL WASTE MANIFEST <br /> 3 L M •�• <br /> 13r1UV^lrilrtGfOMIS INDUSTMES; <br /> Li <br /> Generating <br /> Generalor Name <br /> l-ocnlion_. <br /> , <br /> -1_�- j 1 Phone No. <br /> Phone Ile.No. �....�-� `—� - - Containers Tppr. <br /> --�T .ll�- �. 1 __ o.t3rr�r�, <br /> QFI Nla;tc Code 1--- y 4 Units Na. i tie r It <br /> Guanlit i-yPl C•Ca to <br /> Oescrfplion o1 Waste _. _--,__._ -_.---- 0 <br /> --- - _ T .Truck <br /> L, I- 'I I �I I �I P-Pounds <br /> i <br /> ELF L�J ��i� ��S Y_Yards <br /> p Other <br /> y licable <br /> t hereby certify that the above named material does not coma+n w, has been properly described, <br /> free liqauid as defined by 40 GFR Part 760.10 or an <br /> slate jaw, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state l <br /> classified and packaged,and is in proper condition for transportation according to applicable regulations. <br /> �jjjjfj-it Date <br /> e <br /> Si9rsaluro / <br /> Gr•norwor Authorized Aga <br /> Phone No. / <br /> Truck No. <br /> ;7 s `r i rt' _._ Driver Name(Print} Lt = � <br /> Transporter Narne ; <br /> I Vehicle License No.lState <br /> t I 4 <br /> Address -----= i <br /> • �•. _ Vehicle Certification—_.--�-�{ <br /> that the above named material was picked up f hereby certify that the above named material was delivered with- <br /> I hereby certify out incident to the destination listed below. <br /> al the generator site fisted above. <br /> f f-- Delivery Date <br /> � _ - Drivor S� nature <br /> Shpma,t Dile 9 <br /> Driver Sigrstltsro '- <br /> v <br /> ti ,fw 8'tir'4 <br /> ._d ,�`i / 1 y.V,e 3 !• f ri �'� :7, w,J�, +,1y � �i,.......,..s..,.w <br /> Phone No. l� <br /> Site Name <br /> Address - <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge tile foregoing is true and accurat�e� <br /> l�J <br /> Reem I llate - - <br /> -" <br /> llillMi <br /> r,--. of AuihOri:VA-Arg•'pt:--=-"...�—_---_=���--.�.—.— <br /> PASS CODE <br /> Br-1260720 <br /> IU10G <br /> Ir,r,tt-�r•rzl?liii lislnlii <br />