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q <br /> 3 <br /> No-48G124: <br /> i <br /> II <br /> oMaste <br /> rIAL WASTE MANIFEST <br /> -HAZARDOUS SPE <br /> systems <br /> fj � r <br /> �i.- :• ,114 <br /> 'S :. <br /> I pnovrrntic-fcrin1S irrousrn+es a <br /> -,!' ..y� ,Sf.c <br /> I .tir�F.'E•,'.}•v:}4'��t].r��:� �U '.y'/ + )•(111J.—�---��__.----�— <br /> r (iellarating Loc, lon <br /> 4 Generator Narno Add -Lr <br /> L� <br /> ress_�D�- I � <br /> l <br /> C7t —�Address�_��L�-�•_I-•.�s:-.5:' Let11 r <br /> I ;•t�rl ti�,tr,[.,, rat. ;h4U2 �t�f_`�l--i—�`� <br /> i ------ __ <br /> 3 li fi _phone Na. Zyp© <br /> �r�l 4 containers p.prom <br /> Phone No. LIS <br /> �i �� _ units No. y� C.Carton <br /> ` i duanlil � r�BFf Waste Code �— 17escri lions of W_ e p L) C r -Truck <br /> � `: f_rOl;S <br /> E U P-pounds <br /> t,Uli lr .Zi!i4tt13 t71I-�*E:OU11-1 0 yards <br /> I r�;c_�tV.'.I:�Otr Ul Uild£ h � � p-Olhar <br /> i 40 Cr_R part 260.10 or any apPlicabia <br /> E property described, <br /> ` ttas been prop Y <br /> 40 CFf� Past 261 or anynamed material doe aPPlicable state lay', <br /> ion according to applicable regulations. <br /> I hereby certify that the above waste as defined by <br /> s not contain rt 61 liquid as define <br /> slate law, is net a hazasdou er condition for transport <br /> packaged,and is in prop % <br /> � classified and p �1 � � r�1 <br /> ��rrrF�A Shipmm�t Oato <br /> Em E <br /> I 2c, .SrgtlBturo�r/ 1 a '.L4 a <br /> —�" <br /> Oirrraror AulrrcnFed Agent rF <br /> 415-G34-6650 <br /> f hong <br /> } Truck No. It}c. Driver Narne(Print) <br /> JAII'nru 'irLCf:ir --r-~'— <br /> Transporter Narne��---y Vehicle t lcense Nodstate <br /> Address9h5411 <br /> _ Vehicle Cerliticalion_L <br /> G <br /> Iy�csi, ll iortli a <br /> I hereby certify that the above named materiel was delivered with- <br /> icked up out incident to the deslinat'ion listed below. <br /> I hereby cerlily that the above named material was p'., <br /> at the generator site listed above, peii�nry pat-o'� <br /> COD <br /> '\ r privet Signalure <br /> ���� ^� ShSpnsonl pare <br /> � s <br /> Driver Signaluru � � � <br /> UT F. <br /> :�k;M'i.. .. 1r phone No. <br /> Site NarneI,iV6 rl�f3rer �. 94" <br /> 4QU1 j mt h vasco E'�.r e the foregoing's true and accurate. <br /> Address led and t the best of my knowledge _ <br /> above named material has been ac <br /> 0.i - <br /> U' - <br /> f hereby cattily that the- U <br /> . -r <br /> ........... .. ..nocoi t pal©.. <br /> SianalurR . <br /> PASS CODE Br1260.7i <br /> t tarPa 1-MISPOITTE" F1I<Tnlrt <br /> , <br /> g11111;I <br />