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_ a A—M-7- 5 W1j SKIMr• - ma y==g <br /> a >" -atwad-'�r"".:.+N1r.0 - ' "°'� '-� }trm+tz�_ r� ecaT:t-� EnAs.esr.+x _ a.rm w•xvyrs�eizaytatsi.,nnrnenrse.��rr_-Y •Rrnsea <br /> `.{ Waste M0-4861,1. 7 <br /> Systems ", NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> anotiwrimG-r-Ennis MOUSTMES _ <br /> ���� ������-' <br /> Genoralor Name_- - ._..__' Generaling Location---_-_--____ _,.---..-- -------.--. — --- <br /> Address Address <br /> Phone No. r_ <br /> L'-] . ] r I_ - _❑=1 Phone No. <br /> II I I I I Containers Type <br /> BFI Waste Code __� I I _.]_ . J 1 ..: ._Vi _ 1- ] �. __.� ._._�-- ___. <br /> Description o1 waste Quaniily tlrsils No. T E7e C.Carton <br /> aR <br /> t <br /> t•. t c t lrr_ T •Truck <br /> i i ❑ S� <br /> r r �L—L�._-t—J ❑ P-Pattnds <br /> F_Fj <br /> Y-Yards <br /> O Other <br /> I hereby certify that the above named inaterial does not contain tree liquid as defined by 40 CFR Part 260.10 or any applicable <br /> state law, is not a hazardous waste as dolined by 40 CFR Part 261 or any applicable slate law, has been properly described, <br /> classified and packaged,and is in proper condition for transportation according to applicable regulations. <br /> Gonerllur AUthorized Agefn N,Into 5"","'re. <br /> Shipment Data y <br /> Truck No. Phone No. <br /> r <br /> Transporter Name I`t 1 r'. ?' it _ Driver Name(Print) <br /> Address <br /> s Vehicle License No.lSlate <br /> - �— <br /> Vehicle Certification <br /> I hereby certify that the above named material was picked up t hereby certify that the abnie named material was d0vered with. <br /> at the generator site listed above. out incident to the destination listed below. <br /> Q[ivnr$ryrrature Stzipmont(hole Qrkver SlgnanueY QaBvory Qaur <br /> i. r r C' + - ' •' �L- r-� �`y ! �' �,�r 0]� Edi-`r � k 'k��' '�F�iiri;'?: ���"�`C�L �-�?'•"�=3`� _ <br /> t-" \.L:: u ..+«. .I3S..�.:. XTiif',rt.k,k7°><t'��x.,.�.3'..+�.'t:.iF.r.. c'•i• ai«'`r,7 ;jtz_,��"• <br /> Site Name .I.• t`" '-r-' `__ri s E1 _ �Phone No. <br /> € r• - i .t.-} `�. F�7_7..E.t�.r- -.Z:�-tf:_l:'_`.r ;. _-._.... <br /> Address <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> Receipt D71te <br /> PASS CODE <br /> nrl2c0 720 - <br /> tn,rc <br /> 11 t�.-l,�-E•r7l;[ra l 1 Ir-�;tr{-i <br />