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P; <br /> 4RAW <br /> psq <br /> f <br /> 4 <br /> L.mss, tJn. B G'2 <br /> `� f <br /> ,' T!'= r <br /> WI'.STE MANIFEST <br /> Systems - NON-I-II�ZARC�OUS SPECIAL <br /> E3libt'drJ1t7C fCrttil5 INDUSTRIESJ'7777177. ',r R.�.,'+'wr,-,y'" .r .�y ^'l �s3 7 �+:� 7 -r '41.;• - 4r. 4 f ? ��M:..i1.�-i" <br /> �...�„=...oc..T.rs.•-.*-•r..+±+r�'rrr�.-�---•-x� t ! a PKAT 1 C "1.� �'��8��� r.iis`�?'',.C�.+..sc.. �s...ts.cv�°,s� .v."..w...:xzu.:•ter <br /> Generating Location <br /> GeneratorName --_-- <br /> t !1. Address ---:- <br /> Address------- 4_uir CA <br /> ---r <br /> ----�- , — =J_=� Phone Pto. - <br /> Phdne No,EE - Containers Type <br /> �- D [)rum <br /> F3fl Waste Cade ��� �t«�� - QuantitY�, Units i�No. T Pe C.Carton <br /> Description o!W35'e 1 I i {/ I � Bag <br /> _ T-Truck <br /> ':(;tL:it.'al ❑ l P Pounds <br /> .tIr, L.i,_ ii <br /> Y.Yards <br /> ❑ � � 0.other <br /> EE= — <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicable <br /> 40 CFR Part 26i or any applicable state lavf, has been properly described, <br /> state law, is not a hazardous waste as defined by Mations. <br /> classified and packaged,and is in proper condition for transportatjon according to applicable re 9 <br /> �1 f r shipment Uare <br /> S gnaturo _ �7' <br /> Generator lulhm¢Cd Ag nl Ai�me _ �4 d?"441' a" 'fi+"j• *„m at, <br /> Phone No. T <br /> Tiuck No. <br /> !':! i.:[�, ;r 7�,_•- I�:, !T.u. Driver Name <br /> (Print) <br /> Transporter Nat,ie <br /> f, Vehicle License Nodstate r <br /> Address r1 <br /> ;'_C,.t7;�,. Vehicle Certification ~� <br /> I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> out incident to the destination fisted below. <br /> at the generator site IT led above. <br /> Deiwry Date <br /> rw.i,s.r �• hi tent Cate I Driver Signature <br /> sqimiura <br /> . •r-ror•{-r++i^1;, y�; i9V sr. ;h'. ,"' t �` M>Q ",+�",� rt .� . e <br /> t ; Phone No. <br /> site Name <br /> • r, :.LL> tai., [iv�,cr.urc, �..� , ,,�';G <br /> ',SF, f t•.�, � <br /> Address <br /> 9 and accurate. <br /> -- --- - - -- - -- 1 hereby certify that the above Warned material has been accepted and to il10 host of{my �/ <br /> know dge the foregoing is true f <br /> I <br /> ` r � - EX! J <br /> 'nesei t pato <br /> Sirinalure <br /> r PASS CODE <br /> SF1260-720 <br /> S01Bi <br /> TRANSF'C)s'I'E- i RETAIN <br />