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i <br /> Waste N0.4 8 G 12 <br /> '~ Sy' ems M <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> t1110WlrtavrstrrlG'rEnrtrs u1DtJSTnlrs <br /> -r >-; �C ,��(� 0 �Y iFr _4ti 4f:.,:.1:]r .a.. iv:r t.�~Y +��+iu�. �:i_w.•.aa ___>.s i�. <br /> 7. <br /> G^nertlorJarne — Generating Location <br /> Address1 ` I Address _T_ -- <br /> Phone No. -- <br /> [— I . _l "_.1 C [=_l._._ _l 1 [-- -- Containers Type <br /> - <br /> BFI Wade Cnde rum <br /> Ouasllity Units No. <br /> Description of Waste mm ._ Typ <br /> e <br /> C- ngon <br /> E._L._L_�__I L_] �"�.] U ©-nag <br /> 1 T•Truck <br /> [-L-E—EL Y-Yardsrds P_Yoa $ <br /> —- ` <br /> ED <br /> ❑ 0710 <br /> O:Other <br /> �I hereby certify that the above named material does not contain free liquid as delined by 40 CFR Part 260.10 or any applicable <br /> state law, is not a hazardous waste as defined by 40 CFH Part 261 or any applical:' stale law, has been properly described, <br /> classified and packaged,and is in proper conditionor transportation according to applicable regulations. <br /> EE <br /> G❑maator Auihoured Ageva Mu, qq 5 gnalure `., SWprnnnt[)alo <br /> l4l�y., �. t a �iJ R 1• t ids', r�.� '�''�`jr� F+ n�®�_a._:. -��4 v'sx -�Y'3.,ts�.i:Mh`�'+,f s,d�..7�Gx�'�. bi�'4t"!rr�..3�_,v,���l.n��+ '�:�1 <br /> Truck No. Plione No. — <br /> 1,1t('.i;it,r r i-Ii;;, privet Name(Print) J�. }-[1 _ <br /> Transporter Name — / <br /> 1'-` . 1: " Vehicle License No./slate 21, f j t <br /> Address _ ---- _} <br /> IDS-I� Lc�27�/ <br /> Vehicle Certification <br /> I hereby certify that Ilse above named material was picked up I hereby certify that the above named material was delivered xilh- <br /> at the generator site listed above. out incident to the destination listed below. <br /> SliiUmant Oaln giver Signature �Delivery y�al� <br /> oriver siconalure ,•1�� } { ,�.o w1 �_c� <br /> [ ^] �'[,� T t 4� T f 8 \ 'i].LJ '}�Y� - '4 •tl rq'• i`.. ipuy, �} _7 A':' ' .'�,, <br /> 4 :'r3.1},."..r tYt Y4�• .,Ru1' i "I ..'r.'1.. S. il. : +�4 •b� 1 4'.. ': +t,�.tr���k�'2v�a3 '.1.`f�;C f 4< <br /> t <br /> Sit,)Name I-_r J. t i Phone No. l_J_J— <br /> `-.•rr-I <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> — <br /> tJ:rr.._v1 Aulhmired A�enl� Si�mituro Receipt Dale <br /> PASS cooE <br /> 13F1260.7^0 <br /> tOrry6 , <br /> 3t,�tir.fczf,{�nprpl f�f"T^IfJ <br />