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4 3� <br /> Na 11 <br /> pr' Waste rra <br /> 14, stems I�lON-I-;AZA�DOUS SPECIAL. WASTE MANIFEST <br /> t3Ft01 NUIG TEFIRIS(ftnusrnll <br /> CR <br /> 05 <br /> :, is Generakinr�Location _.. -., _ <br /> Address.._� <br /> nddrOss -- <br /> _ <br /> { I I i 1 1.=- �Itan� f3�. ---- <br /> P tone No. �, -�, _L � -� - TYr° <br /> • s <br /> - f - I € I Canlnujer D.Dnrrn <br /> lI I l l_.-� _-�_. -1 �UuantilY_ I -- -- c C•Carinn <br /> RPI VJastn Code l_- f <br /> Unit flo. FY <br /> Description of Waste _, I p Dag <br /> P.F'auads <br /> Y-Yards <br /> r j D Othnr <br /> L.�I r� a pliGaUle__..-. <br /> 1 hereby certify that Ile above named mate <br /> Irial docs rloi contain tree liquid as defined by t CFR Part 2GO.t0 o y P <br /> stale law, is not a hazardous waste as defined by SID CFR fart 2G1 or any applicable state law, has been properly described, <br /> classified and packaged,and is in proper condition for transportation according to applicable regulations. <br /> _ <br /> f%Iveratir AutlloiizV A" riln �j ;c am <br /> -77 <br /> r <br /> Phone No.- ) <br /> Truck No. _—..- <br /> ! t" [?river Natrle(Print) - <br /> r -._.�.- <br /> Transporter Name <br /> Vehicle License Nu.lState <br /> Address -.--- - , ;- <br /> _ Vehicle Certification --- <br /> above named material was picked up -� I hereby certify that the abntc named material was delivered with <br /> I hereby certily that the out incident to tile destitlation listed below. <br /> at the generator s'ste listed above- <br /> f r�(_1._I`r-r��I__-� •_.�:.� �c� -- - Delivery Pattl <br /> .0 <br /> sr — Shitrmerjt D°Se <br /> S p .i' Mi 4i�•��t� _� 'd���.i.�:,ji.���r�?-.•~`xk1��'.s`� <br /> j a_fi <br /> phone No. t _ � - <br /> Site Name <br /> hereby that the above Aar;led nsaterial <br /> I certify tttas beet~accepted and to the best oS my knowledge the foregoing is true enc!accurate. } - <br /> --- - - -- - - . -EF [r� <br /> 1jl'I^.GO M) <br /> tivrt ..., ,tr-ii igt 'I'lil <br />