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r. <br /> syste s ,rl NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Unr?LVtt1r4G F-EnfrtS IUDUSTMr : { a <br /> Generating Lcration --_- -- -- - <br /> Generator tJalne-- --..-----------� - - <br /> r --- <br /> Address <br /> Address _--- - -- — - - <br /> -- _ - --- <br /> Phone <br /> No. - <br /> f hono No. �_ _� -�- - -- -- Containers fyl:e <br /> _ - <br /> T <br /> D-Qrum <br /> [3FI Waste Code k�-t-.� - ._ ._. ` _ OUar1lity Units -No.. Type C_Carton <br /> Description of Waste - r I f l <br /> --- -- --- -- ---- Li [- d`Day <br /> — <br /> _ -Truck <br /> i I + I l l p-Pounds <br /> EE-0 IJ �_._t-J �— Y Yards <br /> 0—Other <br /> ---- nal <br /> fel EJA ❑ applicable- _. <br /> Y pP described, <br /> L hereby certify that the alcove named material does not contain tree liquid as defined by't0 CFR Part�60.tQ or any <br /> state lativ, is not a hazardous waste as defined by 40 CFR Part 261 or an z 'icable slate law, has been property <br /> classified and packaged, and is in proper condition far t/arrsportation according to applicable regulations. <br /> Geunralor Authuri ud hg nl NO ne <br /> Phone No. --- _ <br /> Truck No. <br /> Driver Name(Print) <br /> Transporter Name 'i '! <br /> Vehicle License No.13tate <br /> Address — <br /> Vehicle Certification <br /> certify that the above named material was picked up Y I hereby certify that the above named material was delivered with <br /> - <br /> I hereby Y out incident to tale destination listed below. <br /> at II)e generator site listed above. <br /> �/�/ .� <br /> 11 ,�`--- —Delivery Dale <br /> _1.�• ��'�L r _. j�.—`�J��i�L --�——1 ❑iivgr f�etinun —._—.�--..._.__ <br /> si ipmanl Uato <br /> UNver Sly 3tme <br /> „ <br /> ro -1 -,Sr n..�, 1} s!'-i ?, ~�1..� -.:�i,,.�.._... ..• r} 51; <br /> P15.a,y�:°Y�} <br /> •~ Ay ]:�t .u....�....._F..: a..rrw.. S stil.tdv �E <br /> - l 1 Phone No. '.--1� <br /> Site Name t <br /> ... �.ii. f ..:I :,, _:G 4.f: r }.!.'.:C; c:t� r ' • -'i�'` ' _—_.—�._.---- <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge lite foregoing is true and accurate. <br /> It--- Flecei l Date <br /> PASS CODE <br /> eF1260.720 <br /> IMG <br /> _t l':'�1`.l•r•s;l i Tt r'rr-r,�it t <br />