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Pm <br /> 4 <br /> Waste <br /> "" S SPECIAL WASTE MANIFEST <br /> systems NON-HAZARDOUS _] <br /> [tl;l]Y1tIMG F-Ensis 111DUSTME5 „ rr. c 'y "s��"'"T'S' <br /> T-77- .5' 7' y�4 ■"' y.$a.`. `2� ri°I,•n.- i., w:S J'�.uicu'�Cn.c ^`� ..:a.�=� <br /> .,-r-.,, .:.•�- R^ra'..•'ly;^t°' ""' _t ) sw'� a': .. "`c <br /> C' ','. S :_. ate. :7�.-'•*�#[. _,t 1:1 <br /> Generating Location —---- -� <br /> {;wtcrnlor Name _.------ <br /> __ Address <br /> Addse55----'----�._---_.�.—_'"_�_ _�—•—�.- Sr: i t,j% ���- <br /> f � LDe_sLcnft�lton�or �e_J <br /> ----------- <br /> PhoneNo. <br /> Containers <br /> [D- <br /> No,QelitPhullr' � UnitsL <br /> Lir.1 Waste code Dyraapurden[ <br /> ot <br /> 13 <br /> n <br /> _. ....------------__-- T .Truck <br /> ❑ <br /> El <br /> P"pounds <br /> Y-Yards <br /> El—,� Q-other <br /> applicable�efinadFFI Part 260.10 Or any ppA0 CFR Part ree iq any applicable state law, has been properly described, <br /> certify that the above named material does oat contain free liquid <br /> proper condition for transportation according to applicaolo regulations. <br /> ;;laic lata, is not a hazardous waste as defined by <br /> ciass'sfied and packaged,and is in prop , f <br /> ! s ! i'•'.'.t' t z 1:'u_-��_��. 5hipmenl O1t0 <br /> a <br /> y �L <br /> rr_�izux A EI}o zed Ag n1.N 7mr Yf,•; � �� 0 _ r k'�.�.i 9•,... u� '' f�, ^•,x`_,'L� r+ ."3 ., i; -+. .. <br /> av F--•--","f'."", 'Et°'"��T'�'�i y"�r> ���y7y�f.n2r.� ,r r�. <br /> �.,. ,� .z_...,�=�-�-ss^•si"'e?=i.::=_f'w�iili+'6iT.,.at. ^r' ��C•..t,{e —•`.)� ir.) <br /> Phone No. <br /> } r 1 <br /> Truck No. 1 . �; I <br /> V,L n <br /> Driver Name(Print) w <br /> Transporter Name !,��---- <br /> ,t _ Vehicle License NO./State , <br /> Address <br /> •,. ,;, s,:_ .l :'.. 'C;„i, ”," ''-' _-�_�_- Vehicle Certification <br /> picked u thereby certify that the above named material was delivered wit r <br /> out incident to the destination listed below. <br /> I hereby certify that the above named material wasp P <br /> at the generator site listed above. <br /> i [ "s Dalivary Dale <br /> [J:ivor signature <br /> 5lnprnen[Dat© - - <br /> Dmrr signawra I •„�-., Fes3 w h s <br /> 7""14 j-J r ! n,,•'T'�"'S'?o .""i.ai .i '..Y'.. <br /> A <br /> T;,°. :•;i f i __��-Phone No. <br /> Site Name <br /> Address_ <br /> I hereby cerlily that the above namod material has been accepted and to the best of my know%dge the foregoing is tr�e and accurate. <br /> necBi t DalO <br /> ila�•-�at Aurlran:ed Arenz_ t,� -- <br /> w PASS CODE <br /> OF1260-720 <br /> taros <br /> rnAlv.;l-'ORTCn i 1ETAIN <br />