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{ r/ <br /> M'M' <br /> Q <br /> Waste 8 C1 1- <br /> YNON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Ui oWillfG-t ErinlS MIJUSTnir-S r- <br /> �^�'�-�'�''� .v�+�'�"p'� r- 7 1 ,�,� .�, e 2 3�A �.-...s.`�s3" ...�:�-tee-•. <br /> "77 �c ""•� CiCneralitlg LOCaIIGn r,t ,^ <br /> Ge0era101'Name <br /> Address <br /> Phone No. l�_L��i —_�l ❑�t �_._� - <br /> PlianeTYPe <br /> I i Containers <br /> �_ D Diurn <br /> 1__ —_L -' Quantity Units Na. TY a Carton <br /> rtr-1 waste c�lil -_. I— ° <br /> Dose nptiun of Waste R BaU <br /> ❑ �L �L {�� l I` T -Truck <br /> ��� ❑ L_ L-J L� P Pounds <br /> Y-Yards <br /> applicable <br /> --------~T--��— 40 CFR ?art 250.10 or any app <br /> hn CFR part 26t or any applicable slate law, has been property described, <br /> I hereby cerlil; that the above named material does not contain [fee liquid as detine y <br /> state law, is not a hazardous waste as defined by Ucable re ulalions, <br /> classiiicd and packaged,and is in proper conc'ition for Uansponation according to app 9 <br /> �l <br /> Ship[nonr polo <br /> Sign ituro >s s''�537 1,•q`.7vi���.'iT^^S�r�t.'i., ''�.,. '1e70. <br /> Agent lm <br /> L ._ 1 f'Y"?��i..'-�`_�w[s-.'.ter-�=•�L"'Ar L"`'."�",y'�"�. „ ..t � •r i <br /> Phone No. <br /> Truck No. <br /> Driver Name(Print) <br /> Transporter Name <br /> Vehicle License No./Stale <br /> yehicle Certification - <br /> -- <br /> was picked up i''i <br /> . I herehy certify that the al)'"named material was delivered with <br /> ce[tif ll,al he above named mater'sal - <br /> I ltereby Y out incident to the destination listed below. <br /> at 1111:generator site listed above" Ij �— ��_j11� <br /> -t-. I_ _ _.-~--__--.�-- -� Qelrvery pato <br /> SI,pn❑ ,t Dale paver g lura Je, h� -",, <br /> Priv,r ,11e 11 t1,e _ ....,•, w-•y^�„^" r� i"%%-j',rk 4;t A <br /> .., s��awt hd ) "ter <br /> Phone No. L.-_❑1-1 <br /> Site Name <br /> j. <br /> Address —.- <br /> _..._ .. .__._ has been accep[ed and to the best or myknowledge the foregoing is true an accurate. <br /> I hereby certify that the ahove.narned material <br /> r � ' <br /> _-_.—�--1�.'•-f/---1� - �r Fleca�pl�alo��_� <br /> ,,.. .=p1 Aull,ari�ed <br /> r'ASS CGDE_--------- <br /> pF1260-720 <br /> 10MG <br />