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_ - - R'„ '��.a.'�' xi w.c•'ingj' A., -+n :s- - 1.23 - -•v'va- - �5.r <br /> CK <br /> -.� Waste NU.48G282' <br /> systems HAZAR " S SPECIAL WASTE MANIFEST <br /> 17 <br /> tG rrnR$S INDUSTRIES <br /> r X+ Y +1 Y f <br /> t31oVjr1t <br /> i ----rs�^--r-"'S, 'e..e',}".,'-".p"�A,a'-r�*`-r'•.r.; f a Iy Pnl �rrw'�i �. ;��� u s r��"N.r,N`�a`F�'�a, � , , <br /> Generator Hanle _.. <br /> Address <br /> Arldrass CA <br /> f� ' 1 ' r. Phone No. <br /> F 1 J—j_ <br /> Phone rJo_ Containers T)'P° <br /> I�L,�� � - C-Drum <br /> 131.1 Wi+sta Codd LTi,I J _ 1_���lll puantit Units f3o. �Yp? C-Carl on <br /> - Description of Waste _ -� €u� D-Bag <br /> �=J t�1.I� <br /> 1 T - Truck <br /> i r.:.. ;:;,::.: c, .t'. : ":,l.k CYf.f1 ❑ ' ' IEj P-Pounds <br /> �.tii 1;lC;.. C1r1Ur'LCCDLSsiU I I! <br /> �'= -•--"+ Y-Yards <br /> t.al". r� n <br /> O-Other <br /> y applicable <br /> 1 or any applicable <br /> state law, has been properly described. <br /> I hereby certify that tl3e above named material does not contain free liquid�definedFR Part 260.iG os an <br /> slate law, is not a hazardous waste as defined by 40 GFR n�E do according to applicable regulations. <br /> classified and packaged,and is in proper condition for transp <br /> _ Srripment Dale <br /> 11-i F 53gnalur0 <br /> / x5 : <br /> r E r A�n.or ced Ar S .yr` ' y r a�•.,`.- + �'-� zri.y, <br /> eer �....snrr- [wc4•c'..,n°' s'I.P1'1.+"T � 3i;� 5a[ C y`v- ,.'. t75 I -. <br /> r7r <br /> Phone No. <br /> Truck No. � � !� <br /> f . i <br /> _ :��'+•r;i s•:1, rr::;.' Driver Name(Print) r r � � <br /> Transporter Name + <br /> Vehicle License No./State <br /> Address .� <br /> VehicleCertification r <br /> I hereby certify that the above Warned material was picked up :hereby certify that the above named material was delivered with <br /> out incident to the <br /> at the generator site listed above. destination listed below. <br /> _^•�! F -�—�'"- shipment Rate Orivur 3ignaturo <br /> Driv[r 5 gniturn <br /> e3i~:.ess- v';t r �l4ySj c .%5 -,p?y� E r3. <br /> Sita Name <br /> Phone No. + - <br /> Address -' <br /> I hereby certify that the above mimed material has been accepted andihe best of my,`knowledge the foregoing 1s true and Z cura>e. <br /> ReCei 1I Dam <br /> i <br /> nature +' <br /> rF.un a}Autle'ized Asenl <br /> PASSCODE <br /> aF1260.720 <br /> 1011;6 <br /> 'rnANSt"O?'r iZR REFAIN <br />