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a <br /> 3 <br /> No./1 8 G 1 1.4 <br /> P111 -- <br /> Waste' NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> nnoNwING T E_T1T1IS 1NDUSTME r aw+ 3 ry e r z t y:rr ax y,lrS rf 1', <br /> �'Tr <br /> C'enarating Location <br /> Generator Name - <br /> Addrc Ss <br /> �T <br /> Address I L.----- --___.— --- <br /> Phone NO. <br /> Plrnno PJn. {:_i--.._I,__4 .- I -1-:_�..-_l -�_'- - <br /> Container s Typr` <br /> . - t]rum <br /> f3Fl Wastr.Code _.._ I - l _ _ Quantity_ __.. Units —ilo ryP° 0.Oarton <br /> j JI <br /> L . . - - _ <br /> Dascnpltan of Wasle __________ F <br /> _— . <br /> - - - <br /> �- <br /> --- ---_. I --� T .'t'mCk <br /> I .. z , i 1. I i�� ❑ P-Pounds <br /> Y.Yards <br /> _ ❑ 0-Other <br /> CE �U � � - — <br /> _ 40 CFE Part 2130.10 or any applical,•le <br /> 4D CFH Pail 2131 or any applicable slate law, has been properly described, <br /> ! hereby certify that the at;ove named material does not contain free liquid as defined by <br /> state law, is not a hazardous waste as defined by licabte regulations. <br /> classilied and packaged,and is in proper cflndilion for transportation according to app 1 / <br /> %.�f't y 7 <br /> i I Shipment Daly <br /> SiynaldrC + t G� g '1`Sla <br /> Generator A'thcr4 d Acts nl rl�t, S +Ps H>T'a'ru;.n1~' jai- ;+r` t w,a�'�` y., -.fix <br /> •'•.4��,�:.S:.Y.�..lY..-�^-.L...^L`f S�i.a.'-�.r.`n.`rs.t. t r 1 <br /> ter-" Phone No. ----- J <br /> Truck No.��—.�—.-- ----------- <br /> �J.rl��'�I�'—'•'�'" —_----- <br /> 1 Driver NaM(Print) <br /> Transporter Name_ -----=— <br /> Vehicle Ucense No./Stale r <br /> Address <br /> I I,_` _ Vehicle Certification <br /> d material was picked up I hereby certify that the above named material was delivered with <br /> the above name <br /> I hereby certify that out incident to the destination listed below. <br /> al the generator site listqabove. <br /> k _ <br /> I Delivery LIM <br /> fI, I <br /> t� {.' l •` • --- 4river SiynalurQ <br /> Sleipr,antData <br /> orivur signature7 <br /> S <br /> Tow4t?�.j.: � <br /> Phone Na. <br /> Site Name — -- <br /> Address . <br /> i1 that the above named material has been accepted and to the best of my knowledge the foregoing is true and acrurate. <br /> hereby certify J <br /> Ifi,."-'oS Authoa�zed Agent_ —_-- -�--�- <br /> PASS CODE_.�.-------"'- - <br /> GFItn r-72,T <br /> loin" <br /> -lf.rslc-,l„11-,rrl? T,clAt!l <br />