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1-L <br /> i <br /> +F <br /> Waste Na 4 8 G 17C <br /> " SysteMS 11 NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> 1`3110MMIG"FERRIS MOUSTMES <br /> U, <br /> r" F�`- <br /> -ie..e> <br /> Generator Name <br /> t !!r '.r I : ci.'.I 1, , _ Generating Location _ __� — — — ----- <br /> ---- ------i <br /> Address I;J l: r l f: j". <br /> Address "---- <br /> °..i. i•' I r � <br /> Phone No. _ <br /> anPllo No. <br /> -- - on N — <br /> _ Containers Typo <br /> [ <br /> Brl waste Corte l._-1— l__._h_1 J I__� 1._-_�__.�_ -. __7 €_—�_---._._ _ D-Drum <br /> Description of Waste Quantity Units No. T O C-Carton <br /> T -Truck <br /> Q� P-Pounds <br /> Y-Yards <br /> O 0131or <br /> I hereby certify that the above named material(lees pol contain free liquid as defined by 40 CFA Part 260.30 or any applicable <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable slate law, has been properly described, <br /> classified and packaged and is in proper condition for <br /> transportation according to applicable regulations. <br /> ...srrS-L 2'.c t,Y� <br /> "rtpmOnri mDole <br /> AuEl_mt'zed Agent Jam4 5 Jnalule y ' <br /> R7. <br /> i- <br /> _a <br /> Truck No.__C_ 7 —._ Phone No. -- <br /> Ir,- it <br /> Driver Name(Print) <br /> !1c_-Lr� <br /> Transporter Name - <br /> Address - T <br /> Vollicle License NoJSlate�`�:' %i r '/ r .• <br /> �'i:l.l it 1 :'.•�.i.l 1:';17,: �:'.'t,t.r; �:r l-, r-7 [l <br /> Vehicle Certification <br /> I hereby cert,ly that the above named material was picked up I hereby certify That 1110 above named material was delivered with- <br /> al the generator 1'110 listed above. out incident to the destination listed below. <br /> ( _L_S.. —__ -- nClivery 01'4 I <br /> Omer$IC•aIV14 Shipmn nt Date Driver Signature <br /> LD <br /> NE <br /> Site Name • r• `i` ._— Phone No. <br /> Address - <br /> - ---- -- <br /> I hereby certify chat the above named material has been accepted and to the,best of my knowledge the (oreg5ing is true an aceurate: i <br /> 51 nature _ neceipl Dale <br /> } <br /> PASS CODE <br /> arizaaa2n <br /> rU�B5 <br /> Ir���rr�:r��rtrt-r� f1E=rnlrl <br />