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«� #Oilr _ <br /> d <br /> Waste <br /> s t <br /> tr <br /> y <br /> ly: <br /> i <br /> j - HAZARDOUS SPECIAL WASTE MANIFEST <br /> �������sTIA NON-HAZARDOUS <br /> nno%vrrlrtG-rrPnis lNousTrtlr s T�-r^* a <br /> -.._ .yam•_•--• -•». I �7e15erikflntl Lacation <br /> Generator Name ---- L_- -- ---- --- <br /> _ Addles _— r'f' ..�.'`- --- <br /> Address__ _ — — _- <br /> [ l i <br /> Phone 7YPc,— <br /> Phone --�_ Containers <br /> Druln <br /> F <br /> �� <br /> Quantity Units No, Y C-Garton <br /> l Y__ _ <br /> BFI Waste Code Description of Waste -��.�__ l �.,I� 1? �� 1 13-f3ag <br /> r I. J ! T .Truck <br /> �� L� P Pounds <br /> El <br /> -- � L_J y.yards <br /> El <br /> licab10 <br /> 41)CFR Part 260.10 or any app <br /> 40 CFF Pall 2Gi or any applicable slate law, has been properly described, <br /> ! hereby certify that th';above named material does not contain free liquid as definedls able regulations. - <br /> state lava, is not a hazardous waste as defined by x'a <br /> classified and packaged, and is in proper condition for transpas[aGon according to app f <br /> H-__ <br /> Uala <br /> Signannn <br /> (,nnnlnio but 10rized Agent Name r i i }1 • ' 'k, ,t„ �Z�" <br /> ',JLs <br /> Phone No. _�•--- - <br /> Truck NO, <br /> Driver Name(Print)_t/c,V�-,----f�E!_ <br /> Transporter Name — <br /> Vellicle License NodStalar— <br /> Addressl�G> >•5_ <br /> t:, y'• Vehicle Certification ��C�— <br /> !Hereby certify that lIle above named material was delivered will'- <br /> o <br /> ! hereby certify that the above Warned material was picked up ut incident to the destination listed below, <br /> a!the generator site listed above. <br /> 1 if <br /> ^rl J EO __ e911Ye1Y D;SSO <br /> DIiYCr Sl�n Rt LlfBv <br /> ,-;=y -�A•f L Shipmem Data <br /> i ! r% <br /> _ _ _ 3: r <br /> Omp,Signalnl4 _ S 6 MPJ 4-Y�li ii Mr•',Si' ^I' 1iY�i C LTi 4T 4 i'Z <br /> -r v .;�. a, } '" 7'1. ,.x, �r�` ' i.'trs A — <br /> '�"r�9� r. S�r�,-a�w-��a,#`�,',-,t',�,��.-•�,. � F�.nssiy.. ""- <br /> -"� Phone No. <br /> Site Name <br /> Address <br /> - - - - -- - <br /> thatihe above named material has been accepted and to tho best of my knowledge the foregoing is true and accurate. <br /> certify Y - - - - --- _ __ l`�- 1' •' <br /> necnil,t Date-- <br /> —�'._--- <br /> pASS CODE -- <br /> ar5zcaa�o <br /> m!,e <br /> f'rI^,tI1 <br />